AU PAIR APPLICATION

AU PAIR APPLICATION

CULTURAL EXCHANGE PROGRAM
About You

Give us your basic information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Phone Number - Additional Contact
Please enter a valid phone number.
Marital Status

SingleMarriedDivorced
Do you have children of your own?

YesNo
Do you have any brothers/sisters?

YesNo
Are you a trained nurse or do you have a similar training in healthcare?

YesNo
Do you have a valid passport?

YesNo
Do you have a clear criminal record?

YesNo
Special Diet Needs Select One

No special dietVegetarianVeganLactose IntolerentFruchose IntolerentGluten free
Do you smoke?

YesNoYes, not at home
Do you have any health problems or allergies? Please explain clearly

Type a question

	YES	NO
Can you swim well?
Can you ride a bike?

Letter to Family

Your future host wants to get to know you. Therefore please fill in the boxes below and present yourself briefly. Write in all languages you can speak well or have basic knowledge of. This will increase your chance of being selected by families since most of them prefer candidates that are able to speak and understand their language. We can email you a letter to help you. DO NOT insert any contact details!
Write a Motivation Letter to Your Future Host

Include the following points: who you are? Why you want to become an Au Pair? Why the candidate should host you? Why you qualify for the position?
Input here, a minimum of a page
Describe your experience as Au Pair. Why would you like to become an Au Pair abroad?
Describe yourself in a few words and tell us about your interests and hobbies. What would you like to do after being an Au Pair?

Legalities
I, (state full name) blanks confirm all the above infomation is correct and is a true reflection and factual account. Made this day blank . By signing through document electronically I confirm all the above.
Signature

Clear
Please verify that you are human*
Should be Empty:

About You