ONLINE APPLICATION FORM
(Fields marked with
*
are required)
First Name:
*
Please include your first name...
Last Name:
*
Please include your last name
Landline:
(including area code)
*
Please include a contact phone number
Mobile Number
Email:
*
Please include your email address
That does not appear to be a valid email address - please check
Address - Street
*
Please include your Street Address
Address - Suburb
*
Please include your suburb
Address - City
*
Please include your city
Gender:
*
Female
Male
Please indicate your gender
Date of Birth:
*
Please include your date of birth...
Country of Birth:
*
Please include your country of birth
Citizen of:
*
Please include your citizenship country
Present Occupation:
*
Please include your current occupation
Do you smoke?
*
Yes
No
Please make a selection.
Is English your first or
native language?
*
Yes
No
Please make a selection.
Do you have a Driver's License?
*
Full
Restricted
No
Please make a selection.
Sorry, you must have a current license to be eligible for this program
If "Restricted" when will you have your full license?
*
Program Interested in:
*
USA
GERMANY
Please make a selection.
Where did you hear about us?
School - Name
Friend - Name
Other - Name
Have you got NCEA Level 2 or equivalent qualification?
*
Yes
No
Please make a selection.
Have you attended:
*
University
Polytechnic
Other*
*If "Other" please list here
Have you any Childcare or Teaching Qualifications?
What type of childcare experience do you have?
*
Siblings/Family
Babysitting for non relatives
Tutoring
Nannying for non relatives
Coaching
Teaching
Camps
Kindergarten/Daycare
Other
Please select at least one to qualify for application
Do you have a minimum of 200 hours child care experience?
*
Yes
No
Please make a selection.
Can you provide 2 childcare references from 2 non relatives?
*
Yes
No
Please make a selection.
Marital Status - Are You:
*
Single
Living With Partner
Married
Separated
Divorced
Please make a selection from the above options
Sorry, married people are ineligible for this programm
Do you have any children?
*
Yes
No
Please make a selection.
Sorry, if you have children, you are ineligible for this programme
Are you in good physical health?
*
Yes
No
Please make a selection.
Have you any physical or mental disabilities?
*
Yes
No
Please make a selection.
Have you ever had a criminal conviction?
*
Yes
No
Please make a selection.
Sorry, if you have had a criminal conviction, you are ineligible for this programme...
Your earliest month of availability to depart NZ?
*
Please include your earliest departure month available
Any Questions?
Please make a selection.
