Anixi Au pair - Application Form
Anixi au pair / Εργασία και σπουδές στο εξωτερικό
Contact Information
Full Name:
Your answer
Date of birth:
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Telephone:
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Best time to call:
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Email:
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Skype:
Your answer
I’m applying to be an au pair in:
Availability
How long would you like to stay:
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Latest starting date:
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Earliest starting date:
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Childcare Experience
Experience with children ages:
Willing to care for children ages:(Please note that the more flexible you are the more options you will have)
Number of children (the more flexible you are the more options you will have):
Please describe your child care experience:
Your answer
I have experience in these areas caring for children 0 – 2 years of age:
I have experience in these areas caring for children older than 2 years of age:
Other*
Your answer
Describe talents/skills you have that are useful when caring for children:
Your answer
Driving Experience
Do you have a driver’s license?
Education and Work Experience
What is your current occupation?
Your answer
Please describe the type of education you have beyond secondary school:
Your answer
Give a brief summary of jobs you have held, duration and duties (including part time andsummer vacation jobs):
Your answer
Skills Interests Hobbies
Language Knowledge
English
French
Other languages
Your answer
Do you have formal safety training or certificates (e.g. First Aid, water safety):
Describe your swimming skills:
Describe any skills/participation in the following areas (including past and current hobbies and interests)Sports, Outdoor (swimming, soccer, skiing, jogging, hiking, sailing, camping, girl scouts, dancing etc.):
Your answer
Arts, Crafts and Creative (cooking, baking, photography, writing, design, handicrafts, gardening, acting etc.):
Your answer
Music (instruments you play, singing, reading music, etc.):
Your answer
Other (computers, travel, board games, reading etc.):
Your answer
Family Background
Describe where you grew up and pets you have/had:
Your answer
Ages and names of siblings:
Your answer
Mother’s profession:
Your answer
Father’s profession:
Your answer
Religion:
Your answer
General
What are your favorite things to do in your spare time?
Your answer
Have you traveled outside your home country for 2 months or more?
Your answer
Please describe a typical evening during the week:
Your answer
Please describe a typical evening during the weekend:
Your answer
Why do you want to participate in the au pair program?
Your answer
Have you been convicted of or charged with a criminal offence?
Do you have chronic/recurring health problems (e.g. asthma, diabetes, depression)?
Do you take any medication?
Do you have allergies or fears of household pets?
Do you have food allergies?
Do you follow a special diet?
Are you vegetarian?
If you are a vegetarian can you cook non-vegetarian meals?
If yes on any, please give details:
Your answer
Do you have any condition that could affect your performance as an au pair:
If yes, please specify:
Your answer
Would you accept a single parent family?
With a single mother
With a single father
Would you accept a family with pets?
If no which animal do you not accept:
Your answer
Do you smoke?
If yes, cigarettes per day:
Your answer
Are you willing to quit smoking?
Do you agree to follow the host family’s rules for smoking?
Do you want to be in contact with other au pairs and do you agree that your email is given to other au pair participants?
By ticking this box, I certify that I have read, approved and agree to Anixi's Terms and Conditions and Integrity Policy.(You can find them on Anixi's website www.anixi.eu).
By ticking this box, I certify that I have no remarks in my criminal record register and I confirm that the information given in this form is true, complete and accurate.
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