Application for Au-Pairs Full Name: Address: City: Country: Nationality: Home Telephone: Required for the interview: country and city code: home number: Mobile: E-mail adress: Your Skype Address, for your interview with a family: Confirm your E-mail Address Personal details Age on departure Date of birth: Day: Month: Year: Sex:MaleFemale Nationality: Marital status:SingleMarriedSeparatedDivorcedWidowed Placement details We have families in main cities and towns, Do you accept living in City:Town:Country: Do you prefer accept any city and town? When would you like to start? Month / year Is this date flexible? would you accept to start before? pls give details How many months would you like to stay? note that the minimum is 6 months Maximum length of stay: (months) Your pictures go here, for a family to see your very best :)! Use nice photos to show the family what you look like. Choose pictures that are friendly and show your very best smile. If possible, use photos of you interacting with children. Maybe a photo of you ‘in action’ showing your favourite sport or hobby! *Please use Ctrl or shift to attach more than one photo Childcare experience “the most important part” What ages have you taken care What ages would you prefer to work with? You will need a minimum of 80 hours of childcare experience (with non family members) to be considered for this program: List all your relevant childcare experience Enter each experience entry individually Make sure the details (dates, ages of children) match the details provided by your referees Childcare Experience 1 Type of Childcare (e.g.babysitting, day care centre, au pair….) Dates (From __ to __) Names of children and ages when supervision began (e.g.Peter – 2 year old, Paul- 3 year old) Duties and activities (e.g. bath time, playing, supervision) “Give full details please” Giving as much information as possible will be a benefit How often you cared them (e.g.:3 hrs twice a week) Name of referee Telephone number and email of this referee Total number of hours gained in this experience Childcare Experience 2 Type of Childcare (e.g.babysitting, day care centre, au pair….) Dates (From __ to __) Names of children and ages when supervision began (e.g.Peter – 2 year old, Paul- 3 year old) Duties and activities (e.g. bath time, playing, supervision) “Give full details please” Giving as much information as possible will be a benefit How often you cared them (e.g.:3 hrs twice a week) Name of referee Telephone number and email of this referee Total number of hours gained in this experience Most families have a baby in their family, Do you accept caring a baby if the mum gives you training for some weeks? (leave the box unchecked means not accepting) Yes, a newborn baby if mum is at home Yes, a baby of 4-6 months old Yes, a baby of 6-8 months old Yes, a baby of 8-10 months old Yes, a baby of 10-12 months old Yes, a baby of 1 yr old Yes, a baby of 1-2 yrs old Do you have a minimum of 80 hours of TOTAL experience? Yes No How many? Did you take care of babies younger than 2 yrs old? if yes, of what age: Please detail your experience with babies: Copy and Paste your Curriculum Do you have a first aid certificate?YesNo Do you accept a family with a single mother?YesNo Do you accept a family with a sigle father?YesNo More details Your Present occupation: Your Knowledge of English:?FluentGoodSatisfactoryFairPoor Other languages spoken and level: French level: Fluent Good Satisfactory Fair Poor Spanish level: Fluent Good Satisfactory Fair Poor Italian level: Fluent Good Satisfactory Fair Poor German level: Fluent Good Satisfactory Fair Poor Your religion: Are you good at swimming?: Have you previously been an Au pair? if yes, give detailsWhat is the most advanced educational or professional qualification that you have obtained? Childcare Qualifications / 1st Aid Certificate? Do you smoke?YesNo Do you have a driving licence?YesNo which one?NoneManual carAutomatic carManual and automatic Will you be able to drive children to school? Yes No Do you play an instrument? if yes, which one? Please paste here a Dear family letter Provide 2 references- someone whose children you have cared for References should be from jobs related to children, paid or voluntary, it can be babysitting We can’t proceed your application if you don’t provide the next information: Reference 1–Full name of person:Did you babysit his/her children? explain His/her telephone number with country & area codes:their full telephone number;His/her country and email address:Reference 2–Full name of person:Did you babysit his/her children? explainHis/her telephone number with country & area codes:their full telephone number;His/her country and email address:Describe your hobbies and interests? It is the Au pair who pays her flight, hosting families will not pay for your flight I, Au pair agree to organise and pay for my own travel expenses, including visa application and flight tickets Verify: Your entered code is incorrect.
