Aupair Interactive

Aupair Interactive Aupair Interactive info@aupairinteractive.com

Adres Woonplaats , Provincie , postcode Nederlands

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Inschrijven als au pair

au pair application form

I am applying to be
In which country do you wish to be placed?

Which city/region
When could you start?
Until?

Personal information

First name
Name
Gender
Postal Address
Postal code / City
Your Country of Residence

Contact Telephone Number
Contact Fax Number
E-mail
Date of birth / /
Leeftijd
Place and country of birth
Your Nationality / Passport(s)

Are you married Yes No
Religion
Education
Do you want to follow a language course? Yes No

Extra information

Have you lived away from home before? Yes No
Have you worked as an au pair before? Yes No
If so, in which country?

Do you have a valid passport? Yes No
Passport number
Are you willing to accept a family with an infant? Yes No
What age group of children are you willing to look after?

Are you willing to work for a family of a different religion? Yes No
Are you willing to work for a single parent?

Are you willing to cook a simple meals? Yes No
Are you willing to do the ironing? Yes No
Where would you prefer to work?

How much expericens do you have with

Waking children and getting them dressed

Putting children to bed

Looking after children from 0 to 5 years of age

Looking after children from 6 to 10 years of age

Looking after children older than 10 years of age

Keeping children occupied

Taking children out(to swim, play)

Making beds

Washing up

Cooking simple meals

Doing the grocery shopping

Performing light household cleaning

Helping out in the garden

Washing/ironing clothes

Are you willing to look after pets? Yes No

Personal habbits

Do you have a driving licence? Yes No
Are you willing to drive in your host country? Yes No
Can you swim? Yes No
Are you a vegetarian? Yes No
Do you have any allergies? Yes No
Do you smoke? If so, please indicate how many cigarettes a day.
Are you willing not to smoke or to smoke outside? Yes No
Weight
Height

languages

How many years did you study English at school?
How would you rate your command of English?

Other languages

German
French
Other languages

Hobbies and interests

Watching televison Yes No
Going to the cinema Yes No
Going to the theatre Yes No
Art Yes No
Pop music Yes No
Classical music Yes No
Traveling Yes No
Reading Yes No
Foreign languages Yes No
Tennis Yes No
Sailing Yes No
Swimming Yes No
Dancing Yes No
Conversation Yes No
Going to parties/discos Yes No
Horse riding Yes No
Pets/animals Yes No
Walking Yes No
Other hobbies and interests (please indicate)

Parents´ address

Name
Postal Address
Postal code / City
Your Country of Residence

Father´s occupation
Mother´s occupation
Ages of siblings
Special remarks or issues we should take into consideration in placing you