|
First
name
|
|
Last name
|
|
| House
no., Street |
|
City/Town/Village |
|
| State/County |
|
Zip/Post
Code |
|
| Email
Address |
|
Country |
|
| Contact/Mobile
Tel. |
|
Home
Tel. |
|
| Age |
|
Date
of birth (ddmmyy) |
|
| Gender |
Female
Male
|
Nationality |
|
| Can
you drive a car? |
No
Yes
|
If yes, length of
license? |
|
| Do
you smoke? |
No
Yes
|
What is your current job/occupation? |
|
| Do
you have a criminal record? |
No
Yes
|
If you have been a student, what
did you study? |
|
| Can you swim? |
No
Yes
|
Father's
occupation? |
|
| Do you like pets? |
No
Yes
|
Mother's
occupation? |
|
| Ethnic
origin |
|
Sister's age(s) |
|
| Religion |
|
Brother's age(s) |
|
|
|
|
| Earliest
start date (ddmmyy) |
|
Latest
start date (ddmmyy) |
|
| Length
of stay |
|
Family
in (1st choice) |
|
| Language
ability for 1st choice country |
|
2nd
choice)
|
|
| What
is your preferred location |
|
(3rd choice)
|
|
Tick the
relevant boxes:
What ages of children do you prefer to care for (years)? |
Would you accept a...
|
0-2
2-4
4-6
|
6-10
10+
|
single Mother
single Father
disabled child
|
family from a different religion
family from a different ethnic origin
|
| Are you capable of assisting with the following |
|
|
Cooking for child
Cooking for family
|
Laundry for child
Laundry for family
|
Ironing for child
Ironing for family
|
Food shopping
Light housekeeping
|
|
|
|
| I (have experience in / enjoy) the
following (tick the
relevant boxes): |
Outdoor Activities
Computer Literate
Cooking
|
Twin Experience
Arts and Crafts
Dancing
|
Tutor Child
Musical Abilities
City driving
|
Worked with babies
Worked with pre-school
Worked with older children
|
|
I consider myself to be (tick the relevant boxes):
|
|
Responsible
Outgoing
Compassionate
|
Well Organized
Warm and Loving
|
Formal
Casual
|
Upbeat and Positive
Quiet and Reserved
|
|
In
the language of your 1st choice country, please describe your
childcare experience; your hobbies; why you want to be an au pair; what you will do when you finish your au pair stay; and why the family should choose you.
|
|
|
| Do you use any medication regularly / suffer from any allergies
/ require a special diet? |
|
|
If yes, please give
details:
|
|
|
|
|
| Please attach your photograph,
here (must be .gif, .jpeg, .bmp, or .png formats.) |
Photo
|
|
Please choose a password, to enable you to access your details on-line.
(At least 6 characters, and no more than 12 characters. Spaces are not allowed.)
|
|
Password
|
|
Verify
password
|
|
