ApplicationForm Candidate
Passphoto
Position required: Au pairAu pair plus Mother help Nanny Housekeeper
-Please take a few minutes to complete the form as much as you can
Last name: / First name:Nationality: / Date of birth:
Female Male / Married Single
Address: / Goal:
Post code: / Email address:
House phone: / What time can we phone you?
Mobile:
Work: / Fax:
Passport number: / Valid until:
Skype name: / How did you find us?
Personal background
Age: / Date of birth:
Place of birth: / Length: / Weight:
Hair colour: / Eyes colour:
Smoker Non smoker
If yes, do you agree to a family no one smoke? Yes No
If you smoke, would you be prepared not to smoke in the family home? Yes No
Do you have allergies? Yes No
If yes, please describe
Are you on specific diet? Yes No
If yes, please describe:
Are you a vegetarian? Yes No
Do you have any illnesses or injuries? Yes No
If yes please describe it:
Have you taken any first aid course? Yes No
Are you registered with other agency? Yes No
Person to contact in emergency:
Have you ever be convicted of any criminal offence? Yes No
If yes, please describe:
Do you have any relative who living in the destination country? Yes No
Could please describe your interest and hobbies:
Any further information:
Family back ground
Father’s name: / Age: / Profession:
Mother’s name: / Age: / Profession:
Number of sister’s: / Age:
Number of brother’s: / Age:
What is their nationality?
Religion: / Are you practising your religion: Yes No
Education/working and duties experience
Education level: / What is your native language:
Knowledge of languages: / English / Italian / French / Spanish / German / Others
Very good
Good
Sufficient
Basic
None
Do you wish to attaint languages classes? Yes No
Do have any work experience? Yes No
Please describe:
What your current work (occupation):
Do you have experience with children? / Household experience
Children / None / Some / Good / None / Some / Good
0-12 months / Ironing
1-2 years / Cleaning
3-5 years / Washing
6-8 years / Cooking
9+ years / Vacuuming
Disabled / Gardening
Describe your work experience with children (also mention their ages):
Do you have driver licence? Yes No / Since when:
Can you drive abroad? Yes No
If you are coming in the summer months, do you realise that there are no classes available and you will be with the children during the day, especially if their mother is working. Yes No
Do you accept that in the summer is no way to change a family? Yes No
Do you have a special wish concerning the family?
How many hours per week are you prepared to work? 25 hours 30 hours 35 hours 40 hours
Dou you accept a single mother Yes No single father Yes No
Would care for a disabled child Yes No Possibly
Do you accept a family without children? Yes No Possibly
Can you swim Yes No Do you like animals Yes No
Preferred Areas
Where do you prefer to live: The county A big city A (small) town
Others:
Preferred Country:
Can you please motivate why do you want to be Au pair?
What is your earliest departure date:
What is latest departure date:
Preferred duration in months:
Others:
AGREEMENT
1- I ...... confirm that I have read all written materials provided by BabsAupairAgency and that I fulfil all criteria. I understand that the Au pair programme is a cultural exchange programme and not contract for work. I am aware that been an Au pair requires a high degree of both responsibility and flexibility and that I must take my duties seriously.
2- I confirm that I have answered all questions honestly. And that all information in the application is true.
3-After confirmation of placement, I shall stay in touch with my host family and shall inform of my travel arrangements. I agree not to travel to my host family until I have received an official confirmation of placement from BabsAupairAgency. Passing on of an introduction (Au pair) to another employer or an arrangement with the host family resulting an (penalty) agreement. I agree to not do any arrangement with the host family without toward the Agency (I agree aliable payment of penalty to Agency amount of €1000,- if I have done that).
4. I shall familiarize myself with all (if any) visa requirements. I shall obtain necessary documents (e.g. a valid passport) prior to departure and shall not enter my host – country without a proper visa (if required.)
5. I am familiar with and agree to abide by all programme guideline and condition, in particular those regarding the number of working hours, au pair duties, pocket money, free time, holidays language courses, transportation cost insurance and the termination of an Au pair Agreement.
6-Upon my arrival in my host country, I shall discuss in detail with my host family the daily or weekly routine and their expectation of the Au pair programme.
7- I shall carry out my childcare and light housekeeping duties with diligence. In addition to my Au pair duties, I agree to keep my room clean and neatand to make a fair contribution to the cleanliness of the common areas of my host family home.
8- I agree to able by all rules set by my host family (i.e. use of the phone, internet access, and facilities within the home, daytime and overnight visitor, curfew, smoking, ect...). During my stay, I shall behave in a manner, which does not reflect badly my host family, both Au pair Agency and my country home.
9- I shall seek the advice of the host family before administering any form of discipline on the children. Under no circumstance shall I hit the children or leave them alone.
10-I shall discuss with my host family any arrangement for holiday for my holidays well in advance.
11-I shall make a concerted effort to experiences and display tolerance toward others.
12-I realize that the success of the Au pair stay depends largely on my own initiative. I shall try to integrate myself into the host family life and should any problem arise, communicate openly with the family and actively seek a solution.
13-If I have any problems or question, which cannot be discussed or resolved with the host family, I shall contact the Au pair agency in my host country for assistance.
14-a) I shall make every effort to resolve any difference with my host family. If no solution can be reached and I shall decide to leave the family, I agree to give 14 days’ advance notice. During this period, I shall performmy normal duties and receive room, board and pocket money. I f I request to be placed with anew family, I realize this involve moving to a different city.
14-b) Under no circumstance I shouldleave the host family or not coming back from my holiday without advance notice.
14-c) Leaving the host family without advance notice resume a penalty of €1000 (directly payable) to the Agency.
15- I understand that I shall be expected from the programme and must return home if I fall to abide by this agreement or programme guideline. If I falsify any information in my application (e.g. regarding smoking, childcare experience, health ect.)
16- I agree to leave my host country before my visa or residence permit expires (if applicable). Or If I’m from EU countries, under no circumstance I will prolonger my work contract without informed the Agency. This will resume a penalty of €1500 to be pay directly to Agency.
17-I shall not undertake anyother paid employment and will perform only those tasks related to the Au pair programme.
18-Should I decide to cancel my application, I shall inform the Au pair Agency at once.
19- I shall notify BabsAupairAgencyimmediately if there an any changes to the information included in my application.
20-I shall not hold BabsAupairAgency responsible for any losses, injury or damage that may occur during my placement.
21 Becoming a member, I agree that some of my details can be displayed on Babsbaupair.nl (to search suitable family) anonym.
22-All documents and information’s submitted will be treated as confidential and remain in the property of the Agency.
First name: Last name:
Date & place:
Signature:
Very important
The information you have give us here will help us match you to a suitable host family.
Before we will be able to match you with a host family, we will also need you to send us by email or post here below documents.
1- A letter of introduction about yourself to the host family including your hobby and your background.
2- Child care reference (Form will be sent to you)
3- Character reference (Form will be sent to you)
4- Certificate of Medical health (Form will be sent to you)
5- Police check (certificate of police)
6- Passport photographs (2), photo’s with children, familyor friends (total 7 photo’s)
7- Copy of your passport
8- Copy of your driving licence (if you have it)
9- CV
10-Birth certificate (translate in English)
Onderkant formulier
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