APPLICATION FORM

*First Name:
Middle Name:
*Family Name:
Address:
Postal Code:
Country:
Phone at Home:
*Mobile:
Skypename:
*Email Address 1:
Email Address 2:
*Current Age:
*Birthday:
*Place of Birth:
*Country of Birth:
*Nationality:
Passport No.:
Driving License No.:
*Did you finished Highschool? Yes No

*Are you currently studying?

 

If yes pls specify

Yes No

*Do you have a College diploma ?

 

If yes pls specify

Yes No

*Your height in centimeters:
*Are you married?

If no: please specify:		 YES NO

*Are you engaged? YES NO
*Are you divorced? YES NO
*Do you have children of yourself?

If yes: please specify:		 YES NO

Can you drive a car? YES NO
Do you drive a car (vehicle) frequently?

If yes: please specify:
If yes: what type of car/vehicle:		 YES NO

*Do you smoke?

If yes: please specify:		 YES NO

*Can you swim? YES NO
*Can you ride a bicycle?

If no: are you willing to learn?		 YES NO

*Do you have any allergies?

If yes: please specify:		 YES NO

Do you have experience with pets?

If yes: please specify:		 YES NO


*What is your religion?
Do you practice your religion? YES NO
*Is your health excellent?

If no: please specify:
If yes: please specify: 		YES NO


*Do you have any criminal convictions?

If yes: please specify:		 YES NO

*Do you experience homesickness?

If yes: please specify:		 YES NO

*Can you speak English? YES NO
*Can you write English? YES NO
*Can you speak another language besides English and Tagalog? YES NO

If yes: Please Specify
*Do you have experience with child care?

If yes: please specify:

(please include ages of the children, your duties, hours per week)		 YES NO

*Do you have experience with elderly care?

If yes: please specify;

(please include ages of the elder people, your duties, hours per week)		 YES NO

*Do you have general work experiences? YES NO
*Are you familiar with first aid? YES NO
*Do you have a first aid certificate? YES NO
*Are you familiar with preparing easy meals? YES NO
*Are you familiar with light house hold choires? YES NO
*Please describe your character in short and tell something about your strong & weak points
*What can the host family expect from you?
*Favorite activities you want to do with children?
*What do you expect from being an au pair?
*My earliest start date
*My latest start date
*Are you registered with other aupair agencies or aupair searchsites? YES NO

*Do you have relatives or friends in the Netherlands?

If yes: please specify;

 

YES NO

*File Attachment:(UPLOAD your RESUME and PICTURE HERE)
Files:
*Required Fields