AU PAIR CHILDRENapplication Form YOUR PLACEMENT FIRST DATE AVAILABLE TO START: LAST DATE AVAILABLE TO START: 6 MESES8 MESES12 MESES LENGTH OF STAY: LAST DATE AVAILABLE TO STAY: Region preferred: TownSuburbCountryside Are you flexible? Position required: Aupair Au pair Plus Demi Au Pair Aupair Minder Would you accept an Au pair for Senior Position? APPLICANT INFORMATION Full Name: Date of birth: Age: City of Birth: Date license obtained Do you have a full driving license? Are you willing to drive in the host country? SiNo Passport or ID card number: Current address: City: Post Code: Email: Phone: Mobile: Facebook account Current Occupation: Any disabilities? Are you taking any medication? Any serious allergies? Precise which one Any special diet? e.g. vegetarian, Do you like pets? Are you happy to live in a family with animals? Can you swim? Do you have any other interests or hobbies (sports, instrument… ) ? Are you able caring for children around water? Have you ever been convicted of or charged with a criminal offence? If yes, give details Steady girl/boy-friend? Do you smoke? What are your reasons for applying to be an Aupair? Have you ever been an Au pair before? How did you find out about the agency? ATTENTION YOU MUST CONTINUE FILLING OUT THE FORM BELOW Send FAMILY Age of Brothers? Age of sisters? Mother’s Occupation: Mother’s Nationality Father's Occupation: Father’s Nationality : What is your native language? What is your religion? Contacto de emergencia 1: Tel: Relationship: Emergency Contact 2 Tel: Relationship: Highest Level of Education: Other Educational and Professional Training/ Jobs that you have held: Future study plans: What is your level of the native language? ExcellentGoodModerateFairPoor How long have you been studying this language? Do you speak other languages? If yes please list Other Languages spoken: Would you like to take classes in your chosen country? Do you have any previous experience in a foreign country? CHILDCARE EXPERIENCE Do you have a child care certificate? First aid certificate? Others? Please give experience in minding children Which age group do you prefer? Newborn 2-5Newborn 5-10months 9-24older than 10 Which age group do you have experience with? Newborn 2-5Newborn 5-10months 9-24older than 10 Would you accept a single parent family? Single mom Yes - No Single dad Yes - No Can you take care of babies? Are you happy to be in sole charge of the children while the parents are at work? Are you happy to take care of children with a disability or special needs? Are you happy to take care of children with a disability or special needs? Do you accept to live in a family with several kids? Would you accept to live in a family of another religion or race? Are you willing to do light housekeeping? Give an estimation of your capacities in the following skills: Ironing: Good Moderate Fair Poor Washing: Good Moderate Fair Poor Housework: Good Moderate Fair Poor Cooking: Good Moderate Fair Poor Signature of applicant: Date: DATE: Introduce yourself by posting some photos of yourself Write a letter to your future host family. DNI: DRIVING LICENSE Send
