Au pair registration – Au Pair Belgium

Apply here as Au Pair

First Name

Last Name

Picture

Choose a file

Max. size: 300,0 MB

Date of Birth

Place of birth

Nationality

Gender

Female Male

Civil Status

Single Married Divorced Cohabiting Widowed

Address

Postal Code

City

Country

Email

Skype ID

Cell Phone

Phone ( home )

Occupation

Student Employed Unemployed Other

General Information

Do you have children ?

yes no

Have you ever been au pair before ?

yes no

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 ?

yes no

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

Dutch French German Other

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 ?

Newborns

Children aged 9-12 months

Children aged 1-3 years

Children aged 3-6 years

Children aged 6-10 years

Children older than 10 years

Please state what type of childcare experience you have

Siblings/family

Day care

School

Nursery

Outside organisation

Kindergarten

Summer camp

Babysitting

Do you have experience with disabled children ?

yes no

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

yes no

Family background

Father’s occupation

Mother's occupation

Do you have any siblings ?

yes no

Number of brothers ( and their ages )

Number of sisters ( and their ages )

Have you ever lived away from your home ?

yes no

What are your current household duties ?

cooking

washing clothes

cleaning

dusting

ironing

vacuuming

making beds

childcare

tidying up

Religious background

What is your religion ?

Do you practice your religion ?

yes no

Are you open for other religions ?

yes no

Do you follow any food prescriptions ?

yes no

Hobbies

Please list your hobbies ?

Do you play any instrument ?

Sports

Do you practice any sports ?

Can you swim ?

Are you willing to go swimming with your host family ?

Can you ride a bike ?

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

yes no

Bring the children to and from school

yes no

Do light housework

yes no

Make the beds

yes no

Wash and iron clothes

yes no

Cook meals

yes no

Shop for food

yes no

Take care of pets

yes no

Bring your own cell phone

yes no

Bring your own laptop

yes no

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

Not at all 30% 40% 50% 100%

Please write further information about yourself

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

yes no

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.

yes

Formulaire de demande pour au pair

Apply here as Au Pair

Tell us about you

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 ?