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.
NDIS Worker Check Expiry Date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Please provide emergency contact name & number
*
Upload Valid Working With Children Check or Blue card / Yellow card
*
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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
Please upload your Infection Control & Prevention Training Certificate of completion
*
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Choose a file
Link to obtain this in the link above.
Cancel
of
Upload your current Australian Drivers licence or Australian Identification Document with your current address
*
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Choose a file
Cancel
of
Please upload your applicable business insurances you have
*
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of
Please upload your qualifications that are relevant, First aid, Certificate IV in fitness or any relevant degrees
*
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of
Please upload your valid in date vehicle comprehensive car insurance
*
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of
Do you transport participants in your vehicle?
Please Select
Yes
No
Please upload your valid vehicle comprehensive insurance
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of
Address
*
Suburb
*
State
*
Postcode
*
Please provide details of all other work you do & how you will manage any potential conflicts of interest. For example - I will not share Fitness Care confidential information with my other work.
*
Signature
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