Thank you, for giving us the opportunity to find you a great family!

Before we get started…

Please make sure that you mail all of the followingwith your application:

An updated child-care-related CV. Including references.
A copy of your ID.
A copy of your driver's license.
A recent colour photo of yourself.

Your details

Name\s
Surname
ID no
Date of birth & Age
Gender
Ethnicity
Marital status
No of dependents
Email address
Cell no
Home tel
Home address
Vehicle (make & model)
Driving experience.

Requirements & Expectations

Available from:
Estimated duration:
Preferred areas:
Live in\out:
Expected salary:
What age groups do have experience caring for:
What is the maximum number of children you feel you would be able to cope with:
Do you have any preferences regarding the sex, ethnicity and ages of the children you will look after:
Days you are available to work, pls include start & finish times:
Monday: / Tuesday:
Wednesday: / Thursday:
Friday: / Saturday:
Sunday: / Public holidays:

Characteristics

Do you smoke? / Yes / No
If so can you commit to not smoking on duty? / Yes / No
Can you swim? / Yes / No
Do you have any disability, if so describe. / Yes / No
Do you suffer from any emotional, personality or nervous disorders? / Yes / No
Do you have any medical conditions? / Yes / No
Are you on any medication? / Yes / No
Have you been in any motor vehicle accidents?
Do you have a criminal record?

Child Care Experience

Do you have any au pair experience if so how many months/years?
Do you have any experience with mentally/ physically handicapped children?
Do you have experience working with children with ADD/ADHD, learning or behavioral conditions?
Do you have any Babysitting Experience if so how many months/years?

Educational Qualifications

List any certificates, diplomas or degrees, the year & institutions they were obtained at?
List any child care, au pair, first aid & any other courses, the year & institutions they were obtained at?
Are you currently studying or plan to in the future, if so what ?

References

Reference 1
Institute/Family:
Period Employed:
Duties:
Salary:
Reason for Leaving:
Contact Person:
Contact Number:
Reference 2
Institute/Family:
Period Employed:
Duties:
Salary:
Reason for Leaving:
Contact Person:
Contact Number:
Reference 3
Institute/Family:
Period Employed:
Duties:
Salary:
Reason for Leaving:
Contact Person:
Contact Number:

Au pair duties

I am prepared to do the following for my Au Pair family & their children :

Get children up and ready in the morning / Yes / No
Prepare breakfast / Yes / No
Prepare lunches / Yes / No
Take children to school / Yes / No
Collect from school / Yes / No
Prepare lunch/snacks for the children / Yes / No
Take the children to extra mural activities / Yes / No
Supervise Homework/assist projects / Yes / No
Take children on outings / Yes / No
Prepare dinner for children / Yes / No
Bath children / Yes / No
Run errands for family / Yes / No
Grocery shopping / Yes / No
Baby sitting / Yes / No
Other / Yes / No

Declaration

I, ______certify the above to be accurate and truthful and I understand that it ismy responsibility to inform Au Pair Link of any employment, either temporary or permanent offered to me by persons (and their agents)to whom I have been introduced by Au Pair Link.

I give permission to Au Pair Linkto use/divulge my ID number in order to request a

criminal record check on my behalf.

I further agree that Au Pair Linkshall negotiate employment on my behalf and that otherthan my interview with potential employers; I shall not enter into any communicationwith them until my employment with such family is confirmed by Au Pair Linkor

unless agreed upon by Au Pair Link.

Signature: ______Place: ______Date: ______