Agency Registration - Lisa's Staffing Solutions

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Birthplace

Marital Status

Partners Name (if applicable)

Do you have children?

Yes

Children's Ages

Home Phone

Mobile Phone

Home Address

Address

City

State

Postcode

Preferred method of contact:

Home Phone

Mobile Phone

Next of Kin/Emergency Contact

Full Name

Relationship

Home Phone

Mobile Phone

Next of Kin Email

Do you have a drivers license?

Yes

Driver's License Type/Number

Auto/Manual

Auto

Manual

Do you have your own car?

Yes

Car Registration

Car Model

Have you ever had your drivers license suspended? If yes, give details.

Are you an Australian citizen?

Yes

If no, do you hold a current Australian Visa?

Yes

Work Visa Details

Does your Australian Visa have more than 12 months remaining?

Yes

Passport Number

Passport Country of Issue

Have you ever been convicted of a criminal offence?

Yes

If yes, please provide details. (Police Check Number)

Do you have a current Working With Children's Check?

Yes

Working With Children's Check Number

Working With Children's Check Expiry (dd/mm/yyyy)

Have you noted Lisa’s Staffing Solutions as an employer on your WWC?

Yes

If you do not have your Working With Children Check you can apply for it here.

First Aid Type

Expiry Date (dd/mm/yyyy)

First Aid Courses

HLTAID003 - Provide First Aid

HLTAID004 - Provide an Emergency First Aid Response

Do you have a degree?

Yes

Where did you complete your degree?

Title of your degree?

Other qualifications?

Children age group you have experience with

Newborns - 6 months

6 months - 12 months

12 months - 2 years

2 years to 5 years

5 years to 10 years

10 years to 12 years

Teenagers

Multiple Birth Families

Large Families

Not Applicable

Age group you excel at?

Do you have experience with:

Washing

Ironing

Cleaning

Shopping

Cooking

Party help

No experience

Cooking Skills

Kosher Experience

Yes

Swimming Skills

Music Skills

Languages

Hobbies

Desired Employment

Childcare (casual night)

Childcare (casual day)

Childcare (permanent part-time day)

Childcare (permanent part-time night)

Before/After School Care

Nanny (full-time)

Live-in Nanny (full-time)

Temp/Short-term Live-in Nanny

Housekeeper/House Manager

Home Help/Elderly Care

Cleaning

Ironing

Cooking

Party Help (serving and washing dishes)

How many shifts would you like each week?

What days/nights are you available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What times are you available?

What is your current employment?

Please upload copies of the following:

Certificates/Qualifications

Choose File

Drivers License

Choose File

First Aid Certificate

Choose File

Medicare Card

Choose File

Passport

Choose File

Photo of Yourself

Choose File

Police Check

Choose File

Resume

Choose File

Working With Children Check

Choose File

Please download, complete and upload the following forms:

Please download and complete the Code of Conduct and then upload here.

DOWNLOAD FORM

Upload Code of Conduct Here

Choose File

Please download and complete the Health Declaration and then upload here.

DOWNLOAD FORM

Upload Health Declaration Here

Choose File

Please download and complete the Registration Form and then upload here.

DOWNLOAD FORM

Upload Registration Form Here

Choose File

Please complete the following training:

Mandatory Reporting eLearning Module

ACCESS TRAINING

(https://www.vic.gov.au/protecting-children-mandatory-reporting-and-other-obligations)

Reference checks

Please list 3 references.

Name

Organisation

Reference Type

Professional

Personal

Field

Childcare

Cleaning

Party Help

Dates of Employment

Reference Contact Information (phone or email)

Best Time to Contact

Name

Organisation

Reference Type

Professional

Personal

Field

Childcare

Cleaning

Party Help

Dates of Employment

Reference Contact Information (phone or email)

Best Time to Contact

Name

Organisation

Reference Type

Professional

Personal

Field

Childcare

Cleaning

Party Help

Dates of Employment

Reference Contact Information (phone or email)

Best Time to Contact

How did you hear about us?

Do you know anyone who has or is currently working for Lisa's Staffing Solutions?

Is there anything else we need to know?

I acknowledge that the information I am providing, including any uploaded documents, will be used solely for the purpose of the job application process and verification. I understand that my data will be securely stored temporarily and deleted from the website once processed. By submitting this form, I confirm that I have read and agree to the Privacy Policy and understand how my personal information will be handled.

Register to join our agency!

Next of Kin/Emergency Contact

Please upload copies of the following:

Please download, complete and upload the following forms:

Please complete the following training:

Reference checks

If you have any questions please email us at:

[email protected]