Application – Christian Au Pair for the USA

PERSONAL INFORMATION.

Name

Address

Country

City

Zip code

Date of Birth *

How old will you be when you want to start?

Phone Number (Land line)

Mobile Number

SKYPE

Email

Social Media communication

Facebook

Instagram

This helps us link you with other au pairs

Passport Nationality *

Gender

Male

Female

Next of Kin Contact Details

Name, phone number and email address for emergencies

Are you a vegetarian?

Yes

No

Do you smoke?

Yes

No

Do you have any piercings or tattoos? If so please specify.

Do you have any health problems?

Have you ever been convicted of a criminal offence?

If yes, please give details.

How will you make new friends? Will it be easy for you?

Do you have a romantic relationship?

Yes

No

What do your parents think of you becoming an au pair?

YOUR AU PAIR OPTIONS.

What is your main reason for becoming an au pair?

Earliest date you can start

What is the longest that you can stay?

From 12 to 24 months

What is your present occupation?

Do you like pets?

Are you a driver? *

Yes

No

In Progress

Are you prepared to work with a single parent?

Yes

No

Not sure

Can you work with handicapped children?

Yes

No

Not sure

YOUR EXPERIENCES.

What experience do you have with housework?

What experience do you have working with children?

What experience do you have working with babies?

How good is your English?

Basic

Good

Very Good

Native

Have you taken any courses in childcare or Health?

Yes

No

What are your hobbies and interests?

RELIGIOUS AND FAMILY BACKGROUND.

Tell us about your family

How did you become a Christian?

Tell us about your church

How often do you attend?

What are your plans when you return home?

UPLOAD PHOTO AND SUBMIT.

Have you applied to any other agencies? If so, which ones?

Where did you hear about us?

Upload a profile photo

Max file size 5MB

Important Information

In submitting this application form you are agreeing not to make a private au pair arrangement for yourself or a friend with one of our families, either before or after coming to the U.S.A.

Depending on the size of your photo the submission of the form might take a minute or two longer – PLEASE DO NOT CLOSE THIS WINDOW UNTIL YOU GET A SUCCESS MESSAGE.

We will keep your data on our computers for up to two years after which it will be erased. It will only be shown to applicants from our website. At any time you can ask us to delete your data.

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APPLY TO BE A CHRISTIAN AU PAIR IN THE USA.

PERSONAL INFORMATION.

YOUR AU PAIR OPTIONS.

YOUR EXPERIENCES.

RELIGIOUS AND FAMILY BACKGROUND.

UPLOAD PHOTO AND SUBMIT.