Operator/Service Details Period of Operation From Period of Operation To Second Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Third Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Fourth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Fifth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Sixth Operator/Service (if relevant)
Qualification 1 - Mandatory Qualification 2 Qualification 3 Other Qualifications 20a) Operation of a child care service Does the person above currently operate a child care service(s), or have they previously had an interest in/operated a child care service(s) in the past 5 years? This includes: experience working with children in any care setting an interest in or a history of operating a care service licenced by a State or Territory Yes No If Yes, First Operator/Service HELP TEXT: Enter the following operator/service details: Name of the operator Name of the service Role undertaken at operator/service Suburb/Town and Postcode of service Operator/Service Details Period of Operation From Period of Operation To Second Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Third Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To
Fourth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Fifth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Sixth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To 20b) Financial management of a child care service In the last 5 years, has the person above: been subject to administration, receivership, liquidation, bankruptcy or debt recovery proceedings been a Director, Shareholder or Trustee of a business entity (for example, a company, or partnership) at the time it was subject to administration, receivership, liquidation (voluntary or involuntary), bankruptcy or debt recovery proceedings? received a sanction in relation to a child care service? Yes No
Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Fourth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Fifth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Sixth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To 20b) Financial management of a child care service
Second Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Third Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Fourth Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Operator/Service (if relevant) Operator/Service Details Period of Operation From Period of Operation To Operator/Service (if relevant)
Main Telephone Number: Mobile: Email Address: 24 – Postal address of external management organisation or individual Postal Address - Same as the business address above? Yes No If No Floor / Building Street / PO Box Suburb / Town: State: Postcode: 25 – External management organisation/individual legal entity status IMPORTANT: Australian, State and Local Governments cannot be engaged as management companies. Legal Entity Private Company Incorporated Body Indigenous Corporation Individual/Sole Trader Organisation established through a specific piece of Commonwealth or State/Territory legislation Partnership Private Company Public Company Registered Cooperative Unincorporated Body 26 – External management organisation/individual ABN status Does the external management organisation/individual have an Australian Business Number (ABN)? Yes No If Yes ABN ABN Branch Number (if applicable) 27 – External management organisation/individual GST registered status