Modelo Formato de Aplicacion

AU PAIR APPLICATION FORM
First Name:
Middle Name:
Last Name:
Email Address:
Phone Number:
Home address:
Facebook profile:
BASIC INFORMATION
Place of birth:
Nationality:
Do you live in a big city a small city a town the countryside
Mother tongue:
Birth Date:
Age:
I can start my program between and
Are you in a relationship? Yes No
Video
GET DREAMS Calle 19# 5-30. Edificio BD Bacata. Office 702. Bogotá, Colombia. Telephone: +57 3103157347 – Email:
info@getdreams.com.co – Web: www.getdreams.com.co
FAMILY
Mother
Name
Surname
Profession
Phone number
Father
Name
Surname
Profession
Phone number
Siblings
Name Age Occupation
Name Age Occupation
Name Age Occupation
Name Age Occupation
EDUCATION
Highest level of education:
Educational and professional training:
Additional languages spoken: (thick the corresponding box)
Language Null A1 A2 B1 B2 C1
English
French
German
Italian
Chinese
Other
Are you currently studying a language? If yes, which?
WORK EXPERIENCE
Do you have a profession?
Have you worked? Yes No
Type of work
Are you currently working?
What kind of work do you do?
DRIVING INFORMATION
Do you have a driver’s license? Yes No
When did you receive your driver’s license?
How often do you drive?
Do you drive a manual car o automatic car?
Please describe your driving experience.
ABOUT YOU PART 1
Have you been abroad before? Yes No
Where?
Purpose and lenght of stay
Have you been an au pair before? If yes, where?
Describe your hobbies, talents or other interests:
Have you ever lived on your own? Yes No

Describe the circumstances
ABOUT YOU PART 2
Do you smoke? Yes No
I am willing not to smoke inside the house.
I am willing not to smoke in front of the children.
Do you play a musical instrument? If yes, which
Do you play any sport? If yes, which
Can you swim? Yes Yes, very well No
Can you ride a bicycle? Yes No
Can you ride a horse? Yes No
Have you taken a first aid course? Yes No
Do you like animals? Yes No
Do you suffer from any allergies? Yes No
Do you suffer from any phobia? Yes No
Religion? Do you practice it? Yes No
Are you vegetarian? Yes No
Do you have a special diet? Yes No
Do you suffer from any diseases? Yes No
Do you take any medication? Yes No
What are you reading?
Describe your best qualities:
MOTIVATION
Why are you interested in being an au pair? (Thick the corresponding box)
Getting to know another culture Living abroad
Working with children Leave the country
Improve my English Seek other opportunities
Other
What cultural aspects of your family and community will you be able to share with
your host family?
CHILD CARE EXPERIENCE
Age Group Hours of Experience

0-3 months old
3 months-2 years old
2-5 years old
5-10 years old
10+ years old
Do you have any experience caring for children with special needs?
If so, please describe your experience and any education or training you have received in caring for children with
special needs.
What do you feel is the most important aspect of a parent/caregiver relationship?
Please describe your previous childcare experiences.

Please be sure to include the ages of the children, your various responsibilities, and how many hours you worked per
week for each.
HOUSEHOLD CHORES
cooking washing dishes
cleaning washing clothes
Tidying up the house vacuum
baking other
PREFERENCES
When is the earliest you can start your au pair duties?
What age of children would you like to work with?
Babies 1-3 3-6 6-9 9-12

How many children would you like to work with?
Can you take care of the children on your own?
Would you be able to look after children with desabilities?
Would you work with a single father?
Would you work with a single mother?

Do you accept to live in a family of another religion?
Where would you like to live?
big city small town in the countryside
I ____________________________________ confirm that all the information

supplied on this form is true and correct. I certify that the above information is complete
and accurate and all important medical. Information has been included.
Date ____________ Signature_______________________

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AU PAIR APPLICATION FORM

Do you live in a big city a small city a town the countryside

I can start my program between and

Are you in a relationship? Yes No

Highest level of education:

Educational and professional training:

Additional languages spoken: (thick the corresponding box)

Are you currently studying a language? If yes, which?

Do you have a profession?

Have you worked? Yes No

Are you currently working?

What kind of work do you do?

Do you have a driver’s license? Yes No

When did you receive your driver’s license?

How often do you drive?

Do you drive a manual car o automatic car?

Please describe your driving experience.

ABOUT YOU PART 1

Have you been abroad before? Yes No

Purpose and lenght of stay

Have you been an au pair before? If yes, where?

Describe your hobbies, talents or other interests:

Have you ever lived on your own? Yes No

Do you smoke? Yes No

I am willing not to smoke inside the house.

I am willing not to smoke in front of the children.

Do you play a musical instrument? If yes, which

Do you play any sport? If yes, which

Can you swim? Yes Yes, very well No

Can you ride a bicycle? Yes No

Can you ride a horse? Yes No

Have you taken a first aid course? Yes No

Do you like animals? Yes No

Do you suffer from any allergies? Yes No

Do you suffer from any phobia? Yes No

Religion? Do you practice it? Yes No

Are you vegetarian? Yes No

Do you have a special diet? Yes No

Do you suffer from any diseases? Yes No

Do you take any medication? Yes No

What are you reading?

Describe your best qualities:

Getting to know another culture Living abroad

Working with children Leave the country

Improve my English Seek other opportunities

CHILD CARE EXPERIENCE

Age Group Hours of Experience

What do you feel is the most important aspect of a parent/caregiver relationship?

Please describe your previous childcare experiences.

When is the earliest you can start your au pair duties?

What age of children would you like to work with?

Babies 1-3 3-6 6-9 9-12

Can you take care of the children on your own?

Would you be able to look after children with desabilities?

Would you work with a single father?

Would you work with a single mother?

Where would you like to live?

big city small town in the countryside

I ____________________________________ confirm that all the information

Date ____________ Signature_______________________

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Date Signature___________