Vragenlijst voor au pairs

Apply here as Au Pair

Tell us about you

Hobbies - Sports

Are you able to/willing to ?

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Apply here as Au Pair

First Name

Last Name

Picture

Date of Birth

Place of birth

Nationality

Gender

Civil Status

Address

Postal Code

City

Country

Email

Skype ID

Cell Phone

Phone ( home )

Occupation

General Information

Do you have children ?

Have you ever been au pair before ?

First date available to start

Last date available to start

Education - Languages - Driving

What is your level of education ?

Name of School - College - University

Date of graduation

What is your current job ?

Do you have knowledge of First Aid ?

Do you hold a driving licence ?

Which language would like to learn while you are au pair in Belgium ?

What is your native language ?

What is your language level ?

English

Dutch

French

German

Spanish

General health information

Are you healthy

Do you take any medicines ?

Do you have any allergies ?

Do you smoke?

Childcare experience

Do you have childcare experience with ?

Please state what type of childcare experience you have

Do you have experience with disabled children ?

Is there any group of children you are not comfortable with ?

Family background

Father’s occupation

Mother's occupation

Do you have any siblings ?

Number of brothers ( and their ages )

Number of sisters ( and their ages )

Have you ever lived away from your home ?

What are your current household duties ?

Religious background

What is your religion ?

Do you practice your religion ?

Are you open for other religions ?

Do you follow any food prescriptions ?

Hobbies

Please list your hobbies ?

Do you play any instrument ?

Sports

How would you describe yourself ( 1 lowest - 10 highest )

Cheerful

Talkative

Open minded

Reliable

Hard-working

Polite

Dynamic

Patient

co-operative

Modest

Are you able to/willing to ?

Work for a single parent family

Bring the children to and from school

Do light housework

Make the beds

Wash and iron clothes

Cook meals

Shop for food

Take care of pets

Bring your own cell phone

Bring your own laptop

Up to what extent are you willing to pay your flight tickets to and from Belgium ?

Please write further information about yourself

Do you allow Au Pair Belgium to publish your application forms on an anonymous basis on its website ?

Declares that all answers given by him/her in this form are correct and true, and agrees that any uncorrect or untrue answer will lead to a cancellation of his/her au pair program in Belgium which implies that the Au Pair Candidate will pay or reimburse his/her all flight tickets from his/her home country to Belgium as well as the return flight ticket back to his/her home country and any other cost born by his/her host family with respect to his/her placement as au pair in their family, and agrees to abide by the Belgian applicable au pair legislation.