AU PAIR SUMMARY

Surnam
First name Sex
e
Country of
Nationality
residence
Email Alternative email
Home phone Mobile phone
Date of birth
Smoking?
(age)
Driving license? If yes, date of
Religion
test
Are you prepared to drive in the host country?
Other spoken languages 1- Advanced ; 2- Good ; 3- Fair ; 4- Basic
(detail languages and
level, see numbers)
Professional Trainings or
certificates like First Aid,
childcare, teaching…
Name & Any sibling? Brother
Mother
profession of Give their s
parents Father name and age Sisters
Earliest
Start
Latest Length of
Last possible day to stay
stay
Number of children Min Max Physical
Care for special needs
you would like to care
children? Mental
for (be flexible)?
Would you go to a family
Would you go to a single Mother
with animals? If no, be
parent family? Father
precise
Preferre Possib Last
Age group of the children AGENCY NOTES
d le choice
0–1 
1–3 
3–6 
6 - 11 
11 - 18 
Elderly care 
Preferre Possib Last
Wishes according the area
d le choice
City 
Town 
Village 
Rural area 
Hobbies and interests

Can you What musical instruments do

swim? you play?
Health (do precise if
you have any health
problem, allergy,
special diet...)

mercredi, 09 février 2011

 AU PAIR SUMMARY
Other requirements?

Additional information?

mercredi, 09 février 2011