Extra Information

(required for Scandinavia)

Name of applicant*

Email address*

Telephone number*

Best time to contact you?*

Education history

Elementary school - from*

until*

High School - from*

until*

College/University - from

until

Employment history

Profession(s) if you have been employed

3 most recent work experiences (3 dernières expériences de travail)

1. Name of company

Dates (from - until)

2. Name of company

Dates (from - until)

3. Name of company

Dates (from - until)

Personal information/history

Have you already been a nanny or au pair before?*

Yes (please explain below)No

Explanation

Please list the childhood diseases you have had

Have you had any serious illness or disability recently? If yes please explain

What other languages do you speak and which level? (weak, average, good, excellent)

Would you be interested in taking language lessons?*

Yes (please specify which language below)No

Language :

Name and contact details of a personality referant (someone you have known for more than 2 years)*

Je certifie l’exactitude des informations et documents transmis dans le cadre de mon dossier d’inscription et j’accepte que l’Agence Pipelettes conserve ces données pour une durée de 5 ans maximum dans l’éventualité d’un nouveau placement ou pour raison administrative (délivrance d’attestation de placement par exemple).