Carers Application Form

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.

  • APPLICANT 1

  • MM slash DD slash YYYY
  • APPLICANT 2

  • 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
    Max. file size: 64 MB.
    • 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

      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
      Max. file size: 64 MB.
      • FULL NAMEDATE
      • FULL NAMEDATE
      • This field is for validation purposes and should be left unchanged.
      Ngunya Jarjum Children
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