AU PAIR APPLICATION - STS

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Applicant’s Name: ___________________________________________________________________ PERSONAL CHARACTERISTICS What is your religious affiliation? _______________________________________________________ What is your level of participation? ____ Active ____ Occasional ____ Never Do you smoke? ____ Yes ____ No ____ Social Smoker If you smoke, do you agree not to smoke in your host family’s home and whenever you are responsible for or with the children? ____ Yes ____ No Are you willing to live in a home with pets? ____ Yes ____ No If no, why not? ______________ Are there any pets that you cannot live with? Please list: _____________________________________ Do you follow a special diet? ____ Yes ____ No If yes, please explain: ______________________ EDUCATION What level of education have you completed? ____ High School ____ Vocational Training ____ Currently in University ____ Completed University ____ Post-Graduate School References—Please list your school references. 1. Secondary School Name: ______________________________ Contact Name: ________________ Position: __________________________ How long have you known this person? ________________ Telephone Number: ______________________________________ Country Code / Area Code / Local Number 2. Post-Secondary School Name: __________________________ Contact Name: ________________ Position: __________________________ How long have you known this person? ________________ Telephone Number: ______________________________________ Country Code / Area Code / Local Number Verified By: ___________________________________________________ Date: ____/____/______ Do you speak any other languages fluently? Please list_______________________________________ DRIVING EXPERIENCE When did you first begin to drive an automobile? ____/____/_______ Month Day Year Do you have a valid driver’s license? ___ Yes ___ No When does your license expire? ____/____/_______ Month Day Year What date was your first driver’s license issued? ____/____/_______ Month Day Year Note: If you plan to drive in the US, you must have both a national driver’s license valid for your entire stay and an international driver’s license (IDL) in your possession before you depart your home country. Please speak with your recruiting agency for more information. When will you obtain your International Driver’s License? __________________________________ How often do you drive? ____ Often (3-7 days/week) ____ Sometimes (1-2 days/week) ____ Never Have you ever driven in snow? ____ Yes ____ No Would you feel comfortable driving in snow? ____ Yes ____ No www.aupaircare.com 3 10/06
Applicant’s Name: ___________________________________________________________________ HOBBIES AND INTERE<strong>STS</strong> Please mark the box of all activities that you are interested in. Circle the three activities that you participate in most frequently: □ Aerobics □ Bowling □ Do-It-Yourself/ □ Gymnastics □ Piano □ Sports Handicrafts □ Animals □ Camping □ Drama □ Handicrafts □ Reading □Swimming □ Artwork □ Community □ Drawing □ Hiking □ Running □ Table Service Tennis □ Badminton □ Computers □ Entertaining □ Horseback □ Scouting □ Tennis Riding □ Baseball □ Concerts □ Fishing □ Karate/Judo □ Skating □ Travel □ Basketball □ Cooking □ Football □ Music □ Skiing □ Volleyball □ Bicycling □ Dance □ Gardening □ Painting □ Soccer □Water-ski □ Boating □ Dining Out □ Golf □ Photography □ Socializing □Windsurf □ Other Hobbies: ___________________________________________ □ Writing FAMILY INFORMATION Mother’s Name: ____________________________ Father’s Name: ___________________________ Occupation: _______________________________ Occupation:______________________________ Do you have any sisters? ____ Yes ____ No Do you have any brothers? ____ Yes ____ No What are their ages? _________________________ What are their ages? _______________________ Please tell us about your family:_________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Have you ever been to the United States? ____ Yes ____ No If yes, where and for how long? _________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ www.aupaircare.com 4 10/06
Page 1 and 2: AU PAIR APPLICATION Congratulations
Page 3: Applicant’s Name: _______________
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AU PAIR APPLICATION - STS

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