travellot AUPAIR APPLICATION

FORM
When completing the following questions, please be as flexible as
possible,
to enable an efficient placement. Please complete ALL fields, stating N/A
where not applicable (ex: smoking, driving)

Photo
A smiling one is
better.

PERSONAL DETAILS (Detalii personale)

First name (Prenume):

Surname (Nume de familie):

Address (Adresa):
Landline (Telefon fix):

Mobile (Mobil):

Email (Email):

Skype id (id de Skype, daca aveti):

Earliest start date (Data de cand puteti

Latest start date (Pana cand puteti astepta):

incepe):

How long do you want to stay? (Cat timp doriti sa stati?)

Min (Minim):
Max(Maxim):
Sex (Gen):
Date of Birth (Data Nasterii):
Height (Inaltime):

Weight (Greutate):

Nationality (Cetatenie):

Passport No (Numar pasaport):

Religion (Religie):

Practicing (Daca practicati religia):

Fathers occupation (Ocupatia tatalui):

Mothers occupation (Ocupatia mamei):

No. of brothers and sisters (if you have) and ages (Frati si surori: nume si varsta):
Do you have any visible tattoo? (Aveti vreun tatuaj vizibil?)
If yes, what and where?
Do you smoke? Please answer truthfully. (Fumati? Va rugam raspundeti sincer!)
If so, how many per day?
(Daca Da, cate tigari pe zi?)

Would you agree to smoke only away from the

home?
(Sunteti de acord sa fumati NUMAI in afara casei?)

Do you have any allergies / disabilities / illness? If yes, please give details.
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(Aveti probleme medicale? Daca da, va rugam dati detalii.)

Do you follow any special diet? If yes, please give details (e.g. vegetarian or for
religious reasons).
(Urmati vreo dieta? Ex: vegetarian sau din motive religioase)

What are your hobbies / interests? (Ce hobby-uri aveti?)

Which sports do you regularly do? (Ce sporturi practicati?)
Can you swim? (Puteti inota?)
Do you have a current driving
license?

Do you like animals? (Va plac animalele?)

Since when? (Data obtinerii categoriei respective)

(Aveti permis de conducere valabil?)

What driving experience do you have? (Ce experienta in condus aveti?)

Are you willing to drive in the UK? (Puteti si doriti sa conduceti in UK?)
Can you play a musical instrument? (Puteti canta la un instrument muzical?)
How well do you speak English? (Cat de bine vorbiti limba engleza?)
[ ] Poor
Fluent
(Slab)
(Fluent)

[ ] Basic

[ ] Average

(De Baza)

(Mediu)

[ ] Good

[ ]

(Bine)

Are you able to hold a conversation in English? (Puteti purta o conversatie in engleza?)
English years learning? (Cati ani ati invatat

Do you read and write in English?

engleza?)

(Cititi si scrieti in engleza?)

Do you wish to attend English classes in UK? (Doriti sa faceti cursuri de engleza in UK?)
Do you speak any other languages? (Vorbiti alte limbi straine? Daca Da, care si ce nivel?)
Have you lived away from home for any length of time (2 months or more)?
If yes, please give details. (Ati locuit departe de casa? Daca da, va rugam dati detalii.)

Have you been an Au Pair

before?

When and where? Please send reference letter

from previous family, if applicable.

(Ati mai fost plecata prin Programul

Au Pair?)

(Daca da, cand si unde? Va rugam sa atasati scrisoare de

recomandare de la acea familie.)

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EDUCATION / EMPLOYMENT DETAILS

Last school / college / university attended (Care sunt ultimele studii?)
If employed occupation (Ocupatia actuala)
Previous occupations (Ocupatiile anterioare)
Have you any first aid certificates? (Aveti certificat de prim ajutor?)
Do you have any professional qualifications with children? Please attach copies of
Diplomas.
(Aveti calificare profesionala cu copiii? Daca da, va rugam atasati copii dupa acele diplome.)

Future educational plans / future ambitions? (Planuri de viitor)

EXPERIENCE WITH CHILDREN AND HOUSEWORK

What age group of children do you prefer? Please be flexible. (Ce grupe de varsta
preferati?)

[ ] 0 2 years
any age

[ ] 2 5 years

(0 2 ani)
(ORICE Varsta)

[ ] 5 years and over

(2 5 ani)

Will you accept: (Acceptati)

[ ] Single mother?
Whole family?
(Mama Singura)
(Toata Familia)

[ ]

(5 ani si peste)

[ ] Single father?

[ ]

(Tata Singur)

How many children would you accept: (De cati copii sunteti dispusa sa aveti grija?)
Will you accept a family of etnic origin: (Acceptati)
[ ] White/caucasian
[ ]Black/asian
any
(rasa alba/caucaziana)
origine etnica)

(indiana, asiatica, negri)

[ ]
(orice

What type of placement would you like? (Ce fel de plasare doriti?)
[ ] Aupair
[ ] Aupair Plus
[ ] Mothers Help
(max 25 ore/sapt)

(max 35 ore/sapt)

(pana la 45 ore/sapt)

Will you accept a child with mild disabilities? (Acceptati un copil cu dizabilitati usoare?)
Will you accept a family who lives in: (Acceptati o familie care locuieste in) recomandam
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flexibilitate

[ ] London
Anywhere
(Londra)
(ORIUNDE)

[ ] Another city

[ ] Countryside

(Alt Oras)

[ ]

(Zona Rurala)

Can you take sole charge of children? (Puteti avea grija de copii SINGURA?)
Can you take sole charge of babies? (Puteti avea grija de BEBELUSI (0 2 ani) SINGURA?)
Would you accept a baby if the mother were also home?
(Acceptati un bebelus daca mama e acasa?)

What experience do you have with children? (CE experienta aveti cu copiii?)

What experience do you have with babies? (CE experienta aveti cu bebelusii: 0 2 ani?)
Are you willing to live with a family with pets / animals?
(Acceptati sa locuiti cu o familie cu animale?)

Are you willing to help look after the family's pets?

(Acceptati sa aveti grija de animalele familiei?)

Can you cook basic food? (Puteti gati mancare de baza?)

What experience do you have of domestic work? (Ce experienta aveti cu treburile
gospodaresti?)

Are you prepared to help with light domestic work? (e.g. washing, ironing, vacuum,
dust)
(Puteti si doriti sa ajutati la treburile gospodaresti?)

Do you plan to return to your home country during your stay in the UK? If so,
when?
(Doriti sa va intoarceti in tara pe perioada contractului? Daca da, va rugam precizati perioada .)
How would you best describe your personality? (Cum va descrieti personalitatea?)
Name, address and phone number of person(s) to contact in case of emergency:
(Datele de contact ale unui membru al familiei)

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I certify that all the above information is correct and true. I understand
and I am in full agreement with the Terms and Conditions of Business of the
travellot Aupairs Agency.
(Confirm faptul ca toate informatiile mentionate sunt corecte si adevarate. Am luat la
cunostinta despre termenii si conditiile agentiei travellot si sunt de acord sa le respect.)

SIGNATURE*

DATE 15.01.2015

* I agree my digital signature is equal to a handwritten signature

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