AU PAIR APPLICATION - STS

More documents

Recommendations

Info

Please Paste a Bright, Clear & Smiling Passport Photograph☺ 2007 OFFICE USE ONLY Agency____________ 2 AP #______________ Last Name: _________________________________________________________________________ First Name: ______________________________ Middle Name: ___________________________ Birth Date: _____ /_____ /_________ Sex: F M Month Day Year City of Birth: ______________________________ Country of Birth: _________________________ Country of Residence: _______________________ Country of Citizenship: ____________________ Nationality: _______________________________ Passport Number: __________________________ Street Address: ____________________________ Postal Code: ______________________________ Native Language: ________________________ Passport Country of Issue: _________________ City: ___________________________________ Country: _______________________________ Email Address: _____________________________________________________________________ Primary Telephone: _______ _______ ______________ Best Time to Call: ________________ Country Code Area Code Local Number Alternate Telephone: _______ _______ ______________ Best Time to Call: _______________ Country Code Area Code Local Number CHILDCARE EXPERIENCE—Check the ages you are experienced and comfortable working with. Experienced With Comfortable With Elite Applicant □yes □no If yes, select the box below that applies □ 3—6 months □ 3—6 months □ 2 years full time academic □ 6—12 months □ 6—12 months study in childcare. □ 1—2 years □ 1—2 years □ 2 year degree/2 year □ 2—5 years □ 2—5 years certification in childcare □ 5—10 years □ 5—10 years □ 2 years full-time as nanny, childcare provider, or nursery/ primary school teacher. Please indicate below the type of childcare experience(s) you have had. ____Siblings/Family ____Day-Care ____Babysitting ____Teaching ____Tutoring ____ Camps _____ Outside Organizations _____ Au Pair/Nanny (Where/what year?)________________________ Please indicate the specialized skills you have as they relate to childcare. _____ Cooking _____ First Aid/Lifesaving _____ Nurses Training _____ Life Guarding _____ Newborn Classes _____ Child Development Can you swim? ____ Yes ____ No www.aupaircare.com 1 10/06
Applicant’s Name: ___________________________________________________________________ EXPERIENCE WITH CHILDREN UNDER TWO YEARS OLD (non-relatives)—In the boxes below, please list your most recent experience with non-relatives under 2 years old. Write GROUP under name if needed. Type of Childcare: _______________________________ Reference Name: ________________________________ Names of the Children: Sex Age Started Age Stopped Start Date: ____/____ /_____ End Date: ____/____/_____ (M/F) ___________________ ______ ________ _________ Total number of months cared: ______________________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ Number of times cared each month: ___________ Number of hours cared each time: _____________ Total # hours: ________ Total # hours under 2: ________ Type of Childcare: _______________________________ Reference Name: ________________________________ Names of the Children: Sex Age Started Age Stopped Start Date: ____/____ /_____ End Date: ____/____/_____ (M/F) ___________________ ______ ________ _________ Total number of months cared: ______________________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ Number of times cared each month: ___________ Number of hours cared each time: _____________ Total # hours: ________ Total # hours under 2: ________ Do you have 200 hours experience with children under the age of two?__ Y ___ N # of hours:______ OTHER CHILDCARE EXPERIENCE—In the boxes below, please list your next most recent childcare experience. You may also include experience you have with your siblings and other relatives. Type of Childcare: _______________________________ Reference Name: ________________________________ Names of the Children: Sex Age Started Age Stopped Start Date: ____/____ /_____ End Date: ____/____/_____ (M/F) ___________________ ______ ________ _________ Total number of months cared: ______________________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ Number of times cared each month: ___________ Number of hours cared each time: _____________ Total # hours: ____________________________________ Type of Childcare: _______________________________ Reference Name: ________________________________ Names of the Children: Sex Age Started Age Stopped Start Date: ____/____ /_____ End Date: ____/____/_____ (M/F) ___________________ ______ ________ _________ Total number of months cared: ______________________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ ___________________ ______ ________ _________ Number of times cared each month: ___________ Number of hours cared each time: _____________ Total # hours: ____________________________________ Au Pair Signature: __________________________________________________ Date: ___/___/_____ www.aupaircare.com 2 10/06
Page 1: AU PAIR APPLICATION Congratulations
Page 5 and 6: Applicant’s Name: _______________

AU PAIR APPLICATION - STS

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?