Standard Service
Children’sServicesAct1996,Children’sServicesRegulations2009
Aboutthisapplication
•Thisapplicationisthesecondstepinthelicensingprocesstooperateachildren’sservice.
•Beforeoperatingachildren’sservice,thechildren’sservice premisesmustbe approvedassuitablebytheSecretaryorDelegateoftheDepartmentofEducationandTraining(theDepartment)andhavea‘CertificateofApprovalofPremises’.
•Whenthepremiseshavebeenapproved,thisformshouldbeusedtoapplyforstandardservicelicence.Astandardserviceisachildren’sservicethatisanearlychildhoodinterventionservice;anoccasionalcareservice;amobileservice;orabudgetbasedservice.
•Donotusethisformifyouintendtooperateanyothertypeofservicebesidesastandardservice.Differentapplicationformsfor othertypesofservicesandanintegratedservice whereonelicenseeisoperating2ormoretypesofchildren’sservices atonepremisesareavailableat
Documentsyoumustprovidewiththisapplication
•AcopyoftheCertificateofApprovalofPremises.
•Ifwithinthelast5yearsanyofthefollowingpersonshavenotpreviouslybeenapprovedasfitandproperbytheSecretaryorDelegateoftheDepartment,acompletedDeterminationofFitandProperPersonformfor:
- Anindividualapplicant
- Alldirectorsorofficersofabodycorporate(company,incorporatedassociation,cooperative,partnership,corporation)whowillormayexercisemanagementorcontroloverthechildren’sservice.
- Anyotherpersonwhoisaprimaryorapprovednominee who willmanageorcontrolthechildren’sserviceinthelicensee’sabsence.
•Ifacompany,afullASICcompanyextract,notmorethan6monthsold,showingthecompany’sstatus,addressofprincipalplaceofbusinessanddirectorandcompanyofficers.
•Ifanincorporatedassociationorcooperative,acopyofthecertificateofincorporationorcertificateofregistration.
•Ifapartnership,thedeedofpartnership.
•Ifacorporation,acopyofthe reportingstructure.
Furtherinformation
•Furtherinformationaboutoperatingachildren’sserviceisavailableat
PrivacyTheSecretarytotheDepartmentofEducationandTrainingiscommittedtoresponsibleandfairhandlingofpersonalinformation,consistentwiththe InformationPrivacyAct2001 (Vic),the HealthRecordsAct2001 (Vic)and otherstatutoryobligationsincludingobligationsundertheChildren’sServicesAct1996(Vic).TheDepartmentofEducationandTrainingmayneedtodiscloseyourpersonalinformationtootherStateandCommonwealthagenciestocheckorconfirmtheinformationyouhaveprovided.Youcanrequestaccesstoorupdateyourpersonalinformationbycontactingus.Ourinformationprivacypolicyisavailableat
CS4
Version (01/11/11)
Licenceperiod
1.Whatlicenceperiodareyouapplyingfor?
1 year3years5years
Applicant’sdetails
2. / Whattypeofapplicantareyou?Individual ...... / -7 Gotoquestion3.
Company ...... / -7 Gotoquestion5.
Incorporated association...... / -7 Gotoquestion5.
Cooperative ...... / -7 Gotoquestion5.
Partnership ...... / -7 Gotoquestion5.
Corporation/GovernmentSchoolCouncil..... / -7 Gotoquestion5.
Individualapplicant
3.Whatisyourfullnameandcontactdetails?
Title (Mr,Mrsetc)FamilynameGivennames
Date ofbirthDaytimetelephonenumberAfterhoursemergencycontactnumberFaxnumber
EmailaddressABN(ifapplicable)
Postaladdress
Buildingname(ifapplicable)
Unit,floor,streetnumberandstreetname orPOboxSuburb/TownStatePostcode
4.Youwillbethecontactpersonforthisapplicationandoperationofthechildren’sservice.Ifyouareunavailable,wouldyouliketonominateanalternativecontactperson?
No-7 Nowgotoquestion8.
Yes-7 Provide detailsofthecontactpersonbelow
Title (Mr,Mrsetc)FamilynameGivennames
Daytime telephone numberAfterhoursemergencycontactnumberFaxnumber
Emailaddress
Postaladdress
Sameaspostaladdressinquestion3
ordifferentpostaladdressnominatedbelowBuildingname(ifapplicable)
Unit,floor,streetnumberandstreetname orPOboxSuburb/TownStatePostcode
Nowgotoquestion8.
Bodycorporateapplicant
(company,incorporatedassociation,cooperative,partnership,corporation/GovernmentSchoolCouncil)
5.Fullnameofcompany,incorporatedassociation,cooperative,partnership,orcorporation/GovernmentSchoolCouncil
ACN(if applicable)ABN(ifapplicable)
Postaladdress
Buildingname(ifapplicable)
Unit,floor,streetnumberandstreetname orPOboxSuburb/TownStatePostcode
6.Whoistherepresentativeofthebodycorporate?Thisisthepersonthebodycorporateappointsinrelationtothisapplicationandtheoperationofthestandardservice.Thisperson willbethemainpointofcontactfortheDepartmentandothersindealingwiththelicensee.
Title (Mr,Mrs,etc)Family NameGivennames
Daytime telephone numberAfterhoursemergencycontactnumberFaxnumber
Emailaddress
Representative’spostaladdress Sameaspostaladdress inquestion5ordifferentpostaladdressnominatedbelowBuildingname(ifapplicable)
Unit,floor,streetnumberandstreetname orPOboxSuburb/TownStatePostcode
Iftherepresentativeisunavailable,whoisanalternativecontactperson?
Title (Mr,Mrs,etc)Family NameGivennames
Daytime telephone numberAfterhoursemergencycontactnumberFaxnumber
Emailaddress
7.Providedetailsofthedirectorsorofficersofthebodycorporatewhowillormayexercisemanagementorcontrolovertheoperationofthechildren’sservice(mustbeatleastonedirector/officer).ThesepersonsmustbeapprovedasfitandproperbytheSecretaryorDelegateoftheDepartment.Alsolistthosedirectorsandofficerswhowillnotexercisemanagementorcontrolovertheoperationofthechildren’sservice?Ifmorethan8directors/officers,photocopythispageasneededorattachseparateliststitled‘Directors/OfficersinManagementorControl’and‘Directors/OfficersNotExercisingManagementorControl’.
Directors/Officerswhowillormayexercisemanagementorcontrolovertheoperationofthechildren’sservice
TitleFamilyNameGivennamesDateofbirth
Directors/Officerswhowillnotexercisemanagementorcontrolovertheoperationofthechildren’sservice
TitleFamilyNameGivennamesDateofbirth
Children’sservicepremisesdetails(tobecompletedbyallapplicants)
8.Nameofchildren’sservice
9.Addressofchildren’sservicepremises(P.O.boxescannotbeaccepted)Buildingname(ifapplicable)
Unit,floor,street numberandstreetnameSuburb/TownStatePostcode
VIC
Daytime telephonenumberFaxnumberEmailaddress
Children’sservicepostaladdress
Sameas postal addressinquestion 3Sameaspostaladdressinquestion5
ordifferentpostaladdressnominatedbelowBuildingname(ifapplicable)
Unit,floor,streetnumberandstreetname orPOboxSuburb/TownStatePostcode
10.InwhichLocalGovernmentAreaistheservicelocated?(egPortPhillip,SwanHill)
11.SincebeinggrantedtheApprovalofPremises,hasanythingchangedinrelationtothestructure,designorlocationofthechildren’sservice’spremises?
No-7 Gotoquestion12.
Yes-7 Please detail all changesbelow
Operationofthechildren’sservice(tobecompletedbyallapplicants)
12.Providedetailsofhoweachchildren’sroomandoutdoorspacewilloperate.
Foreachroomandoutdoorspace,listthedaysandhourstheservice willoperateinthatroom/space,thenumberofchildren’splacesinthatroom/spaceandtheagesofthechildren who will becaredfororeducated inthatroom/space.Ifyouneedadditionalspace,youcanphotocopythispageasneededorattachaseparatelisttitled‘Operationofthechildren’sservice’whichincludesthedetailslistedbelow.
Theroom/outdoorspaceareanumbersgivenheremustcorrespondtothefloorplanordiagramsubmittedaspartoftheApprovalofPremises.
Room/ Out- door Space No.on floor plan / Foreachdaythistypeofservice willoperateinthisroom,listthehoursofoperation / Proposed capacity of child placesfor this room / Agesof children(range)Mon / Tues / Wed / Thu / Fri / Sat / Sun
13.Whatisthetotalnumberofchildren’srooms,outdoorspacesandcapacityofchildren’splacesatthepremises?
Totalnumberof children’s roomsTotalnumberofoutdoorplay spacesTotalproposedcapacityofchildplaces
Educationalorrecreationalprograms(tobecompletedbyallapplicants)
14.Outlineoftheeducationalorrecreationalprogramsthatwillbeprovidedforthechildren
Managementandcontrolofthechildren’sservice(tobecompletedbyallapplicants)
15.Whenthelicensee(individuallicenseeormanagingbodycorporatedirectorsorofficers)arenotpresentatthepremises,youmustprovidedetails ofallotherpersons whowillormaymanageorcontrolthechildren’sserviceinthelicensee’sabsence.Thesepersonsareyournominees.
Therearethreetypesofnominees:
PrimaryNominee.Thepersonwhowillhaveprimaryresponsibilityformanagingorcontrollingthechildren’sserviceinthelicensee’sabsence.ThispersonmustbeapprovedasafitandproperpersonbytheSecretaryorDelegateoftheDepartment.
ApprovedNominees.Personswhowillormaymanageorcontroltheserviceonaregularorscheduledbasis.ThesepersonsmustbeapprovedasfitandproperpersonsbytheSecretaryorDelegateoftheDepartment.
Acceptednominees.Personswhowillormaymanageorcontroltheserviceonashort-termorirregularbasis.
ThesepersonsdonotneedtobeapprovedbytheSecretaryorDelegateoftheDepartmentbutthelicenseemustensuretheyarefitandpropertomanageorcontrolachildren’sservice.
Ifyouneedadditionalspacetolistallnominees,photocopythispageasneededorattachaseparatelisttitled‘Nominees’ withthedetailsbelowandspecifywhichtypeofnomineeeachpersonis.
PrimaryNominee
Providethenameoftheprimarynominee
TitleFamilyNameGivennamesDateofbirth
ApprovedNominees
Providethenamesofallotherpersonswho willormaymanageorcontroltheserviceonaregular/scheduledbasis
TitleFamilyNameGivennamesDateofbirth
AcceptedNominees
Providethenamesofallotherpersons whowillormaymanageorcontroltheserviceonashort-term/irregularbasis
TitleFamilyNameGivennamesDateofbirth
Correspondence(tobecompletedbyallapplicants)
16.Wherewouldyoulikecorrespondencetobepostedtoregardingthisapplicationandongoinglicencerequirements?(chooseallthatapply)
Applicant’s/Licensee’spostaladdressBodycorporaterepresentative’spostaladdressThechildren’sservice’saddress
Declarationandsignature(tobecompletedbyallapplicants)
17.Ideclarethat:
•theinformationinthisapplicationandanyattachmentsaretrueandcorrect;
•allpersons whowillormayexercisemanagementorcontroloverthechildren’sservicehavebeenlistedinthisapplication;
•thattheprimarynomineeandallapprovednomineeswhowillmanageorcontrolthechildren’sserviceinthelicensee’sabsencehaveeitherbeenpreviouslyapprovedasfitandproperbytheSecretaryorDelegateoftheDepartmentwithinthelast5yearsortherequiredfitandproperdocumentationhasbeenprovided withthisapplicationandwrittenconsenthasbeenprovided;
•allnominees who willormaymanageorcontrolthechildren’sserviceintheabsenceofthelicenseearefitandproperpersonsinaccordancewiththeChildren’sServicesAct1996andtheChildren’sServicesRegulations2009;
•IhaveassessedallacceptednomineesasfitandproperinaccordancewiththeChildren’sServicesAct1996andthe
Children’sServicesRegulations2009,includingreviewing:
− acurrentassessmentnotice(WorkingWithChildrenCheck)oracurrentcertificateofregistrationasateacher(VictorianInstituteofTeachingregistration);
− relevantqualificationsorcertificatesofcompletedtraining;
− anymentalorphysicalconditionthatmayimpairtheirabilitytooperateorexercisemanagementorcontroloverachildren’sservice;and
− informationfromatleast2refereesprovidedbythepersontoattesttotheirintegrity,goodcharacterandrepute;
•ifabodycorporateapplicant,therepresentativenamedinthisapplicationisproperlyappointedbythebodycorporateasitsrepresentativeforthestandardservice;
•ifabodycorporateapplicant,thebodycorporatehassufficientfinancestooperatethechildren’sserviceandmeetitsdebtsandthisapplicationissignedinaccordancewiththerulesgoverningthebodycorporatelegalentity.
Whomustsign:
Individuals:Theindividualapplicant.
Company:Twodirectorsofthecompany,oradirectorandcompanysecretary,orifsoleproprietorthesoledirector.Incorporatedassociation:ThePublicOfficerandoneothermemberofthemanagementcommittee.
Cooperative:Twodirectorsofthecooperative,oradirectorandoneotherofficerofthecooperative.
Partnership:Amanagingpartnerwhoisauthorisedtosignonbehalfofthepartnership.Thissignaturebindsallpartners.Corporation/GovernmentSchoolCouncil:Signedinaccordancewithrulesofthecorporation/council.
SignaturePrintednamePosition (if bodycorporate)Date
X
SignaturePrintednamePosition (if bodycorporate)Date
X
Documentchecklist
Youmustprovidethefollowingdocumentsaspartofyourapplication.
Forindividualapplicants:
AcopyoftheCertificateofApprovalofPremises.
Ifwithinthelast5yearsnotpreviouslyapprovedasafitandproperpersonbytheSecretaryorDelegateoftheDepartment:AcompletedDeterminationofFitandProperPersonformforyourself.
AcompletedDeterminationofFitandProperPersonformfortheprimarynomineeandallapprovednomineeslistedinquestion15.YoudonotneedtoincludethisformforAcceptedNominees.
Forbodycorporateapplicants:
AcopyoftheCertificateofApprovalofPremises
Ifacompany,afullASICcompanyextract,notmorethan6monthsold,showingthecompany’sstatus,addressofprincipalplaceofbusinessanddirectorandcompanyofficers.
Ifanincorporatedassociationorcooperative,acopyofthecertificateofincorporationorcertificateofregistration.Ifapartnership,thedeedofpartnership.
Ifacorporation,acopyofthe reportingstructure.
Ifwithinthelast5yearsnotpreviouslyapprovedasafitandproperpersonbytheSecretaryorDelegateoftheDepartment:
AcompletedDeterminationofFitandProperPersonformforalldirectorsorofficersofthebodycorporate whowillormayexercisemanagementorcontroloverthechildren’sservice.
AcompletedDeterminationofFitandProperPersonformforanyprimarynomineeandallapprovednomineeslistedinquestion15.YoudonotneedtoincludethisformforAcceptedNominees.
Whattodonext
Attachdocuments
•Makesureyouhaveattachedallrelevantdocumentsspecifiedinthedocumentchecklistoryourapplicationwillbedelayed.
Paytheapplicationfee
•Theapplicationfeemustbepaidatthetimeofapplication.Thereis noGSTpayableonanyfee.
•Theapplicationfeeamountdependsonthenumberofchildren’splacesyouproposetoprovideandhowlongyouwantthelicenceperiodtobe.Feeamountsarelistedinthefeessheetat
Howtopay
•Bychequemadepayableto‘DepartmentofEducationandTraining.
Lodgeyourapplication
Byposting to:DepartmentofEducationandTraining
QualityAssessmentandRegulationDivision
ServiceAdministrationandSupportUnit
GPOBox4367MelbourneVictoria3001
Whathappensthen
•Youwillreceiveanacknowledgementthatyourapplicationhasbeenreceived.Youmayneedtoprovidefurtherinformation.
•Ifchangeshaveoccurredinthestructure,layoutorlocationofthepremisessinceyouweregrantedtheapprovalofpremises,youmayneedtoresubmitdocumentsshowingthenewlayoutorlodgeaseparateApplicationforApprovalofAlterationsorExtensionstoPremisesform.IfthisisthecaseyouwillbecontactedbyanofficerfromtheDepartment.
•AChildren’sServicesAuthorisedOfficerwillcontactyoutoarrangeanonsiteinspectionofthepremises.
•Afterthefinalinspectioniscomplete,you willbenotifiedofthedecision.
•Ifanychangeoccursintheinformationyouhaveprovidedinyourapplication,youmustnotifytheDepartmentofEducationandTrainingassoonaspossible.