Absolut Au Pairs

20 Clovelly Street

Woodhill Estate

(012) 993 4114

ABSOLUT AU PAIRS

AU PAIR APPLICATION FORMDATE ______

PERSONAL DETAILS

First Name & Surname______

Contact Number/s______

Email Address______

Residential address______

______

Date of birth ID Number______

Age______

Father’s NameOccupation of Father Contact Numbers

______

Mother’s NameOccupation of MotherContact Numbers

______

How many siblings in your family? And their ages?

______

How would you describe your family?

______

How would you describe your relationship with your family?

______

Do you regularly attend religious services?______

What is your religion?______

Is it important that you have a host family of the same religion?

______

Have you ever been charged or convicted of a criminal offence? Give Details:

______

Have you ever taken narcotics / non prescription drugs? Give Details:

______

Do you suffer from emotional, personality or nervous problems? Please describe

______

Can you swim? ______

Do you have a disability? Please describe ______

Do you have any allergies? ______

Are you on any medication? ______

What are your long term goals? ______

______

Personality

What best describes your personality and lifestyle: (Circle appropriates)

PositiveNegativeOutgoingShy

LoudCalmAthleticAttentive

OrganisedCreativeLovingArtistic

SocialWittyMessyNature Lover

IndependentHonestHardworkingResponsible

CaringDependableLazySporty

CleverAverageFun LovingExciting

EXPERIENCE AND SKILLS

What times are you available to au pair?

Day / From / To
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What date will you be available from? ______

What areas would you like to work in? ______

Would you prefer: Live-inLive-out

Would you prefer: PermanentTemporary

Would you prefer:Half-dayFull-day

What is the maximum number of children you would be able to cope with: ______

I have experience with children aged (circle all that apply)

0-12 months1-2yrs3-5yrs6-8yrs9-12yrs12yrs+

Please provide duties:

______

______

I want to work with children aged (circle all that apply)

0-12 months1-2yrs3-5yrs6-8yrs9-12yrs12yrs+

Do you have any preference as to sex and ethnicity of the children? Please state:

______

Why do you want to be an Au Pair?

______

Why do you like these ages? Please be specific:

______

Do you have any experience caring for mentally / physically handicapped children? If yes, please provide the details:

______

Do you have experience working with children with ADD/ ADHD, learning or behavioural problems? ______

Which of the positions below would you like to apply for: (circle appropriate)

Au Pair workTutoringBaby sittingLifting

CHILDCARE REFERENCES

1. Family: ______

Duration: ______

Contact Number: ______

Responsibility: ____________

2. Family: ______

Duration: ______

Contact Number: ______

Responsibility: ____________

DRIVING ABILITY

Do you hold a full drivers licence? ______

Do you have any endorsements on your licence?______

Have you ever had an accident?______

How often do you drive?______

What car do you drive?______

Is your motor vehicle roadworthy?______

Is your motor vehicle insured?______

SMOKING

Do you smoke cigarettes? If yes, how many a day?

______

NON SMOKING DECLARATION:

The vast majority of families have strong views on smoking. If you do smoke, but agree not to in the home of your host family, or when responsible for their children, then tick YES below. You will be expected to abide by your decision, so consider it carefully.

YESNO

EDUCATION

Have you completed 12 years of school?

______

What year did you matriculateand at what school?

______

Subjects Completed and Symbols Obtained:

1. ______2. ______

3. ______4. ______

5. ______6. ______

7. ______

What is the most advanced educational or professional qualification that you have obtained?

______

What Au Pair Related Qualifications do you have?
______

What are your future plans for further education?

______

INTERESTS AND HOBBIES

Please circle the areas that best describe your interest and hobbies:

SwimmingHorse RidingCyclingSnow Skiing

WaterSkiingSnow BoardingTennisRunning

GymnasticsWritingReadingArts and Crafts

MusicalInstrumentsPianoGuitarViolin

Flute ChoirDancePhotography

ArtworkComputersCommunity Service

How do you spend your spare time?

______

Do you have any other talents or special skills which may be useful when caring for children e.g. First Aid?

______

AU PAIR DUTIES

Would you be prepared to do the following?YesNo

Get children up and ready in the mornings:
Prepare breakfast:
Pack lunches:
Take children to school:
Fetch children from school:
Prepare lunch and/ or snacks:
Take children to extramural activities:
Supervise/ assist with homework/ projects:
Take children on outings:
Prepare dinner for children:
Bath children:
Run errands for family:
Grocery shopping:
Travel with family:

AU PAIR REMUNERATION

Remuneration depends on your experience as well as hours worked per week. As your agency, Absolut Au Pairs will negotiate the best rate with the family, either as an hourly rate or a fixed monthly rate. The family will pay this directly to you. As an Au Pair you can expect a rate between R40 and R50 per hour depending on your experience and qualifications. These rates do not include travel. Travel could be reimbursed by R2.50 per km. Usually the family would decide to include or exclude a travel allowance. If a employee should have a temporary placement, he/she will be required to include times travelled on their time sheets to be reimbursed.

Where did you hear about Absolut Au Pairs? ______

AU PAIR LETTER

On the accompanying page, write a letter to your prospective family. Include the following:

  • Why you want to be an Au Pair
  • Any relevant Childcare experience
  • Interests, hobbies and goals for your future
  • About your family
  • Your personality and characteristics
  • What is your definition of a good Au Pair

DECLARATION

I,declare that the information supplied is true and correct.

I understand that it is my responsibility to inform Absolut Au Pairs of any employment, both temporary and permanent, offered to me by persons (and their agents) to whom I have been introduced by the agency.

Absolut Au Pairs will not accept any liability for your conduct prior, during or after the period of employment with the host family. As soon as you are employed by a host family, the relationship is between the host family and yourself and Absolut Au Pairs is excluded there from.

Signature of applicant ______

Date and place signed ______, ______

AU PAIR MOTIVATION LETTER

______

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