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(03) 9576 7000

South Australian Representative

South Australian Representative

Client details

First Name*
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Last Name*
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Email address*
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For the purpose of completing the final face-to-face component of the In-Home Care interview process, as per standard 1.1C of the South Australian standards for In-Home Care services, Armadalia Pty Ltd will require your family to nominate a South Australian resident who you believe meets the below criteria.

The person nominated:

- Is 18 years or older

- Is an Australian citizen

- Has known you for at least 12 months

- Is not a relative, or in a de facto relationship

- Does not live at the same address with you

- Is willing to enter into an agreement with Armadalia Pty Ltd as outlined below

- Is capable of completing the scope of representation as outlined below

- Is willing to submit a co-signed agreement to Armadalia Pty Ltd, upon conclusion of the scope of representation outlined in Section 2

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Please enter information about your Nominee below:

Representatives Full Name*
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Representatives Email address*
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Representatives Address*
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Representatives Mobile Number*
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Armadalia Pty Ltd will authorise and appoint your nominated representative, to physically represent Armadalia Pty Ltd in a face-to-face meeting / interaction with the successful applicant who has indicated that they wish to accept the In-Home Care role. (the agreement they will enter into is outlined below)

1. Purpose:

For the purpose of completing the final face-to-face component of the In-Home Care interview process, as per standard 1.1C of the South Australian standards for In-Home Care services.

2. Scope of Representation:

Representative's authority is limited to the specific purpose outlined in Section 1.

Representative shall not act on behalf of Armadalia Pty Ltd in any other matter without separate written authorization.

Representative shall site and confirm the validity of the applicants photo identification documents.

Representative shall have the applicant co-sign and electronically submit this agreement to Armadalia Pty Ltd.

Representative is not authorized to make any commitments or assertions to the applicant and shall refer any queries the applicant may have directly back to Armadalia Pty Ltd.

3. Armadalia Pty Ltd Instructions:

Armadalia Pty Ltd will provide Representative with all necessary information and instructions prior to the face-to-face meeting / interaction.

Armadalia Pty Ltd will be responsible for ensuring that Representative has all required documents and materials.

4. Representative's Responsibilities:

Representative will act in good faith and in the best interests of Armadalia Pty Ltd.

Representative will follow Armadalia Pty Ltd’s instructions and maintain confidentiality.

Representative shall submit the co-signed agreement to Armadalia Pty Ltd, upon conclusion of the scope of representation outlined in Section 2.

5. Entire Agreement:

This Agreement constitutes the entire agreement between the parties and supersedes all prior or contemporaneous communications and proposals, whether oral or written.

The Representative will be provided with an electronic form, that they will be required to add the below information to and co-sign at the conclusion of the face to face meeting / interaction.

[Face to Face Address]

Representative Signature

Signature: ____________________________

Date: ____________________________

Applicants Signature

Signature: ____________________________

Date: ____________________________

I confirm that the nominated Representative will meet face-to-face and cosign a document with our proposed Educator*
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