Application form

Application form New-Zealand

(Formulaire d'inscription NZ)

Merci de compléter ce document EN ANGLAIS. L'envoi par mail se fait automatiquement à la fin.

Contact information

Gender

Female Male

First name *

Surname *

Mobile *

Skype

landline *

Email *

Address line 1 *

Address line 2

Town *

postcode *

Personal information

Nationality *

Passport expiry date

DOB *

Mother tongue *

Current situation *

Level of HOST country language *

Other languages spoken

Smoker *

If cigarette smoker, how many do you smoke per day?

Food

Allergies

Whatever my personal dietary requirements I agree to prepare food for the family as they wish *

Yes No

Drivers licence *

Test date

Religion

Practising

Siblings

Latest certification

Subject

Can you ride a bike ? *

Can you swim? *

Your interests and hobbies (sports, musical instrument, activities...) *

Describe your personality *

Childcare diploma

1st aid qualification

Family preferences

Dates of stay

From *

To *

Location

Large city Town Village

Maximum number of children

Under 2 baby experience

oui

Willing to look after age group *

0-2 3-5 6-10 10+

Housework tasks willing to do (tâches ménagères prêt(e) à effectuer)

*

Vacuming (Aspirateur) Laundry (gérer les lessives) Basic cooking (faire la cuisine) Dusting (Poussières) Ironing (Repassage)

(Ces tâches font souvent partie du rôle de l'au pair, nous vous conseillons d'être le plus flexible possible)

Do you wish to attend languages classes during your stay

Would you accept the following placements (Accepterez-vous les placements suivants) :

Single parent families

Disabled children

families with pets

Childcare experience (Expérience de la garde d'enfants)

Experience 1

Dates and duration *