Start your journey Educator Application Form Personal details Date First name(s) Surname Date of birth (Must be over 18 years old) Home address Mailing address (if different) Phone Mobile Email Ethnicity Collected for statistical reporting only Emergency contact Experience & qualifications Please describe any experience you have had caring for young children Early Childhood qualifications Please provide photocopied evidence of qualifications. Other relevant qualifications (e.g., Nursing, First Aid) Confidential referees (name, address, phone) – not relatives; known for 2+ years; preferably seen working with young children Work history (last 5 years) Dates, place of work, role Please explain any gaps in work history (e.g., maternity leave) All about you Do you smoke or use electronic cigarettes (e‑cigarettes/Vape)? If so, how will you provide a smoke‑free environment? Do you have or have you had an illness, operation, or disability that may affect your ability to carry out the functions and responsibilities of this role? (e.g., epilepsy, asthma, heart condition) Do you have a full NZ Driver Licence? Select Yes No Do you have a current First Aid Certificate? Select Yes No Are you able to provide care during school holidays? Select Yes No Are you able to commit to play/music/gymnastics groups? Do you have a vehicle suitable to transport children? If renting, do you have your landlord’s permission to provide home‑based care? Select Yes No Not applicable Have you ever applied to and been turned down by another childcare provider or foster care agency? If so, please give details. Do you have a preference for the age of children you would like to care for? Which days and hours are you available to care for children? Other people in your home – Safety checking List all adults (17+) living in your home and their relationship to you. All must undergo Police vetting and 4‑step safety check. Visiting Teacher will need to sight and copy at least one primary ID and one secondary ID (if only one primary provided). Adults in home (17+) Children (under 17) living or receiving care in your home and relationship to you Rules and regulations – Home‑based Educator Please read and acknowledge the following summary. Full licensing criteria: Ministry of Education – Regulatory framework for ECE. I have read and agree to adhere to the regulations and requirements outlined. Full name Date Interview preparation (to be completed at interview) These questions are for the applicant to consider responses prior to the interview. The Visiting Teacher or authorised person will complete this section as part of Children’s Worker Safety Checking (Children’s Act 2014). Guide: Safer Recruitment, Safer Children. 1. Why have you applied to be an Educator? 2. Have any complaints been made about your professional practice? If so, how did you respond? 3. Why did you leave your previous jobs? Situations & responses (describe a time or what you would do): Views on child‑safe practice: discipline, being alone on the job, responding to accusation of abuse Experiences & relationships in working with children Submit
