We are focused on caring for community during the COVID-19 crisis, minimising all face to face contact by working remotely. We are available 9am to 4:30pm 6626 3700. Please take care of yourself,  your family, and loved ones.

Ngunya Jarjum Aboriginal Child & Family Network Inc.
PO Box 580, LISMORE, NSW 2480
70 Carrington Street LISMORE NSW 2480
Phone (02) 6626 3700 | Fax (02) 6622 5500

After Hours: 1800 822 863
ABN: 84 653 612 066 | ICN: 2418

CARER APPLICATION FORM A

PLEASE NOTE:

All Carer Applicants, as well as any additional household members over the age of 18 listed on the application, must have a current Working With Children Check (WWCC).

Before proceeding, complete any applications at:

https://www.kidsguardian.nsw.gov.au/child-safe-organisations/working-with-children-check

When you receive your WWCC, please attach it in the area below.

Thank you again for your interest in becoming a carer.

CARERS APPLICATION

  • APPLICANT 1

  • Date Format: MM slash DD slash YYYY
  • APPLICANT 2

  • Date Format: MM slash DD slash YYYY
  • OTHER PEOPLE WHO LIVE IN YOUR HOME

    This includes all adult household members and children who reside at the premises for a period of 21 days or more. PLEASE NOTE: any household member over the age of 16 years will require a National Criminal Records Check and over the age of 18 years will also requires a NSW Working with Children Clearance.
  • NAMERELATIONSHIPGENDERDATE OF BIRTHWORKING WITH CHILDEN CHECK CURRENT? (YES/NO)
  • NAMERELATIONSHIPGENDERDATE OF BIRTHWORKING WITH CHILDEN CHECK CURRENT? (YES/NO)
  • NAMERELATIONSHIPGENDERDATE OF BIRTHWORKING WITH CHILDEN CHECK CURRENT? (YES/NO)
  • NAMERELATIONSHIPGENDERDATE OF BIRTHWORKING WITH CHILDEN CHECK CURRENT? (YES/NO)
  • NAMERELATIONSHIPGENDERDATE OF BIRTHWORKING WITH CHILDEN CHECK CURRENT? (YES/NO)
  • IF YOU DO HAVE A POOL, PLEASE PROVIDE A COPY OF YOUR POOL REGISTRATION CERTIFICATE AND POOL COMPLIANCE CERTIFICATE.
  • Drop files here or
  • EMPLOYMENT

  • ARE YOU CURRENTLY EMPLOYED?
  • ARE YOU CURRENTLY EMPLOYED?
  • TRANSPORT

  • APPLICANT 1
  • APPLICANT 2
  • HEALTH STATUS

    PLEASE NOTE THAT POTENTIAL CARERS ARE NOW REQUIRED TO COMPLETE THE CARER MEDICAL QUESTIONAIRE
  • APPLICANT 1
  • APPLICANT 2
  • PLEASE NOTE IF YES, YOU WILL BE ASKED TO PROVIDE A COPY TO THE NGUNYA JARJUM CARE TEAM
  • REFERENCES

    PLEASE GIVE THE NAMES OF TWO PEOPLE THAT CAN GIVE YOU A REFERENCE AND AREN'T RELATED TO YOU. ONE OF THE REFERENCES MUST BE ABORIGINAL OR TORRES STRAIT ISLANDER (ATSI) AND ACKNOWLEDGED. IF THROUGHOUT THEIR COMMUNITY. IF 2 APPLICANTS, REFERENCES CAN INDICATE THEY RELATE TO BOTH APPLICANTS.
  • NAMECONTACT DETAILSRELATIONSHIP
  • NAMECONTACT DETAILSRELATIONSHIP
  • TYPE OF CARERS REQUIRED

    NGUNYA JARJUM PROVIDES CARE FOR A RANGE OF CHILDREN AND YOUNG PEOPLE TO THE AGE OF 18 OUR CHILDREN AND YOUNG PEOPLE REQUIRE VARIOUS TYPES OF CARE.
  • NGUNYA JARJUM ALSO PROVIDED CARE FOR A RANGE OF HIGH NEEDS CHILDREN AND YOUNG PEOPLE THESE INCLUDE CHILDREN AND YOUNG PEOPLE WITH BEHAVIOURAL, MEDICAL AND A RANGE OF OTHER NEEDS.
  • PLEASE UPLOAD ALL CURRENT WWCCs HERE
    Drop files here or
  • FULL NAMEDATE
  • FULL NAMEDATE
  • This field is for validation purposes and should be left unchanged.