Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Confirm your valid active Australian Business Number (ABN)
*
NDIS Worker Check ID
*
If you don't have this yet please let us know.
Please provide a reference & there contact details
Please provide emergency contact name & number
*
Upload Valid Working With Children Check or Blue card / Yellow card
*
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Drag and drop files here
Choose a file
Cancel
of
Please upload your NDIS Mandatory Orientation module certificate
*
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Choose a file
Details on what you need to complete are in the link above.
Cancel
of
Upload your current valid Australian Drivers licence or Australian Identification Document
*
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Choose a file
Cancel
of
Please upload any insurances you have - professional indemnity & public liability
*
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Choose a file
Link to apply for combined disability care services & fitness instructor insurance above.
Cancel
of
Please upload a recent infection control training certificate
*
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Choose a file
Cancel
of
Please upload any qualifications that are relevant, first aid, Certificate IV in fitness or any relevant degrees
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Address
*
Suburb
*
State
*
Postcode
*
BSB
*
We need this so we can pay you
Bank Account number
*
We need this so we can pay you
If referred by an existing Fitness Carer please write their name here.
Signature
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