Please complete this form if you are a Care Recipient/Authorised Representative wanting to register a worker, or a Service Provider wanting to register your services. This must be done prior to supplying services and submitting invoices.
Name of Provider *
Name of Home Care Package Client *
Provider Address *
City *
State * Please SelectAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia
Postcode *
Phone Number *
Email Address *
Individual or Sole TraderOrganisation
Clinical Care/Allied Health (eg Registered Nurse, Podiatrist, Physio, Occupational Therapist)Personal CareCleaningGardening, Mowing and Domestic SupportTransportMedical AdministrationOther (Please Describe)
Please describe the goods/service you are providing *
Clinical Care/Allied Health (eg Registered Nurse, Podiatrist, Physio, Occupational Therapist)Personal CareCleaningGardening, Mowing and Domestic SupportTransportMealsEquipmentOther (Please Describe)
Australian Business Number (ABN) *
National Police Check *
Public Liability Insurance ($20M Minimum) *
Proof of Right to Work (eg Passport, Citizenship Certificate, Birth Certificate) *
Fee Type *
Fee ScheduleHourly Rate
Fee Schedule / Price List
Hourly Rate
Complete your Agreement with ALC Home Care *
Please copy and paste the following link into a new browser window, download, and attached a signed version into the upload box: https://drive.google.com/file/d/14adp0PnCoaLoTC0Eb-aLf0SpHYT7nT8V
Would you like to be featured on our app for other opportunities?
YesNo
Username or email *
Password *
