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APPLICATION FORM AU
PAIR

PERSONAL INFORMATION

LAST NAME:
FIRST NAME:

SEX:
DATE OF BIRTH:

COUNTRY OF BIRTH:
ADDRESS:
CITY:
COUNTRY:
NATIONALITY:
ZIP CODE:
PASSPORT / I.D.:
MARITAL ESTATUS:

PHONE NUMBER:
MOBILE NUMBER:

E-MAIL:
SKYPE USERNAME:

CHILDCARE EXPERIENCE

Have you ever been an Au Pair?

Yes

No

Could you, please, provide any details?

Who did you work with?
If you have worked as a Baby- Sitter or as an Au
Pair, how old were the children that you took
care of?
Did you have a nice experience working like
that? Was the family happy with you?
What experience in childcare do you have?
What experience do you have in the following
areas?

A Little
Bit

Very Good Good

None

Looking after babies

Helping children bath
Change nappies
Helping them get dressed
Helping them doing homework
Entertaining children/ play with them
Cooking and tide the kitchen
Going to the supermarket
Vacuuming
Making beds
Laundry
Ironing

Other things that you are able to do?

YOUR POSIBLE HOST FAMILY

How many children would you like to

care of? And why?
I would like to care of children who
are

Newborns 1-4 years 5-9 years 8-12 years

Would you work with a family where

mothers or fathers are single?

Yes (

No (

Would you work with a divorced

mother or father?

Yes (

No (

Are you agree to live with families

where the way of thinking could be

different to yours?

Yes (

No (

Would you live in a family with pets?

Yes (

No (

Would you work for a family with

disabled children?

Yes (

No (

If yes, do you have previous

experience? How long did you work for
them? What kind of things did you do?
How is the ideal family for you?

AU PAIR READY TO GO

When are you available to start?

How long do you want to stay in the host
country?
Have you ever lived in a foreign country?
How long? Where?
Why are you interested in working as an Au
Pair? What are your principal incentives?
Order the next kind of cities for your
preferences: 1st, 2nd, 3rd and 4th.

Big city Small City Town Rural area

Have you ever been convicted of a criminal

offence?

YOUR LANGUAGES KNOWLEDGES

Which is your native language?

Can you speak other languages?
Choose your level.
Spanish
English

A2 B1 B2 C1 C2

French
German
Portuguese
Chinese
Arabic
Other languages
Do you have any certificates?
Would you like to go to a spanish
academy while your experience as an
Au Pair? How many hours/week?

FREE TIME AND HOBBIES

What do you do in your free time?

What sports do you practise?
Can you swim?

Yes (

) No (

Do you like cycling?

Yes (

) No (

Do you play tennis?

Yes (

) No (

Do you like dancing?

Yes (

) No (

Can you play any musical instruments? Yes (

) No (

Can you ride a horse?

Yes (

) No (

Do you like handicrafts?

Yes (

) No (

Other comments:

ABOUT YOUR DRIVING LICENCE

Do you have a current driving licence?

Yes (

) No (

Do you drive regularly?

Yes (

) No (

Would you be prepared to drive your hosts

family car?

Yes (

) No (

Do you have any first aid training?

Yes (

) No (

Are you used to drive in the motorway?

Yes (

) No (

When did you received the licence?

Have you ever driven in a foreign country?

Where and when?

USEFUL INFORMATION ABOUT YOUR HEALTH

Are you healthy?

Yes (

) No (

Yes (

) No (

Are you vegetarian?

Yes (

) No (

Have you ever had any psichological

disorders?

Yes (

) No (

Are you willing to refrain from smoking in the

Yes (
host family?

) No (

Yes (

) No (

Yes (

) No (

Yes (

) No (

Do you have any illnesses? Can you precise

them?
Do you suffer from any allergies? Can you
give us some details, please?
Are you allergic to animals?
Are you taken a current medication? What
type of medication?
Are you on a special diet? Has this ever had
an unhealthy impact on you?

Do you smoke? If yes, how many cigarettes

per day?

Do you drink alcohol very frequently?

Could you please give us details?

RELIGION

Are you religious?

Which is your religion?
Do you attend to religious services?
If yes, what kind of services?
Would you live in a family whose religion is
different to yours?

SELF DESCRIPTION
YES NO
Talkative
Quiet

Cheerful
Outgoing
Sporty

YES NO
Artistic
Honest
Reliable
Independent
Affectionate

Can you describe your self in the following gap?

We are going to give you a real situation in the following example. How could you react?

- Imagine that you are allowed to leave alone at home the children that
you care of and you decide to go shopping for half an hour. Their
parents went out for lunch and suddenly, one of them call you
because there was an accident in the house. What do you do?

a) I dont believe what children tell me. They are always joking.
b) I leave all I am doing at this moment and I go straight away to the
house.

c) I call their parents and I ask them If they could go home.

I certify that the above information is true and correct. My2Home, is not responsable for
any false statements made by the Au Pair.

Date and place

Signature