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AU PAIR Application Form

This document is an application form for au pair positions. It requests information about the applicant's general information, education, childcare experience, age group preferences, family background, employment history, availability, and emergency contact. Documentation of prior childcare experience or training for children under age 2 is required. The form also asks yes or no questions about punctuality, substance use, driving record, medical conditions, and willingness to comply with program requirements.

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2K views3 pages

AU PAIR Application Form

This document is an application form for au pair positions. It requests information about the applicant's general information, education, childcare experience, age group preferences, family background, employment history, availability, and emergency contact. Documentation of prior childcare experience or training for children under age 2 is required. The form also asks yes or no questions about punctuality, substance use, driving record, medical conditions, and willingness to comply with program requirements.

Uploaded by

safindit
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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AU PAIR

APPLICATION
FORM

GENERAL INFORMATION
First Name Attach a
Last Name Age passport size picture
of
Birth Date yourself
Address here

(Be sure to smile!!)


Phone Number Hair Color
Fax Number Eye Color
Cell Phone # City of Birth
Email Address Country of Birth
ID Number: First Available Placement Date
Areas preferred: Last Available Placement Date

EDUCATION

Level of Education Reached


Educational and Professional
Training
Languages Spoken

EXPERIENCE (childcare, home management, medical, teaching, etc.)

Responsibilities How Often


Type of childcare experience Dates Ages of Children
(Duties: changing diapers, (daily, Name of Reference (include
(Baby-sitting, daycare, youth group, (years and months
bathing, games, walking, weekly, telephone number)
au pair, nanny, tutoring, etc.) From To when started)
etc.) monthly, or?)

The SA Government requires that au pairs looking after children under the age of two (2) years must have 200
verifiable hours of previous experience and/or training with children less than two years of age. As many of our
Host Families have children under the age of two, please provide documentation of your experience or training
to enable you to be placed with one of these families.

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AU PAIR APPLICATION FORM
AGE GROUP EXPERIENCE AND PREFERENCES
Experience with Age Groups Preferred Age Groups
Family Preferences
(Tick appropriate groups) (Tick as many as desired)
3 – 24 months 3 – 24 months AU PAIRS @ WORK will place you
2 – 5 years 2 – 5 years with a family suitable to your age,
5 – 10 years 5 – 10 years experience and background. If you
Over 10 years Over 10 years do NOT wish to be placed with a
□ Special Needs □ Special Needs family like the following, please mark
Describe special care given: Special care preferred: it.

a single parent family


a family with different religious beliefs
a family of an alternative lifestyle

List interests, talents, school activities and


honors:
Do you swim, ski, have a background in or
experience with arts & crafts, music, dance?
Do you cook or have other child-related skills
that a host family should know when
reviewing your file? Please list.
Would you like to be placed with a family that
has pets?
Do you have a first aid certificate?

FAMILY BACKGROUND
Father’s Name Occupation
Mother’s Name Occupation
Address
Telephone Number Are they supportive of your
Cell Phone Number decision to become an Au Pair
Number of Children Place in Birth Order
Religious Affiliation Attendance Frequency

EMPLOYMENT HISTORY (don’t list jobs already listed in the EXPERIENCE section)
Present occupation Employer
Address/Telephone Date started
Prior occupation Employer
Address/Telephone Date started
Prior occupation Employer
Address/Telephone Date started

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AU PAIR APPLICATION FORM
Please answer yes or no to the following questions. Answer truthfully.
Yes No Yes No
1. Are you punctual? 12. Do you have a criminal record?
13. Do you have any financial
2. Are you available for live-in positions?
commitments?
14. Do you have any physical or mental
3. Have you lived out of the country?
limitations?
15. Are you currently taking any
4. Have you ever taken illegal drugs?
medication?
16. Do you have any medical conditions
5. Do you drink alcoholic beverages?
requiring treatment?
6. Do you smoke? 17. Do you have any allergies?

7. Do you have racial prejudices? 18. Do you have any dietary restrictions?

8. Do you have any traffic tickets? 19. Are you a vegetarian?


20. If you are a vegetarian, can you cook
9. Have you been in a traffic accident? or be placed with a family who eats
meat?
10. Do you currently have a steady 21. Are you willing to sign a NON
relationship? SMOKING declaration?
Please explain the details for all items to which you
11. Have you ever been married?
answered “yes”

Driving Information
Do you have a driver’s license?
When did you receive your driver’s license?
How long have you been driving?
How many hours a week do you drive?
Do you feel comfortable driving with children?
Do you have your own car?
Does your car have rear seatbelts?

Emergency Information
Name
Address
City, Province Postal Code
Phone

A certified copy of I’d., driver’s licence, passport sized photo and R100-00 administration fee is required with
this application form. Candidates who fail to comply with these will not be considered for placement.

Ilse Seifert 082 308 6364


Fax: 086 523 1318
Email: [email protected]; [email protected]
Web: www.aupairsatwork.co.za

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