Au pair registration form

First name *

Surname *

Address *

Postal code *

City *

Country *
AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGuernseyGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIsle of ManIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyIvory CoastJerseyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSouth Georgia South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States minor outlying islandsUruguayUzbekistanVanuatuVatican City StateVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenZaireZambiaZimbabwe

Gender *
FemaleMale

Telephone number *

Mobile phone number *

Work phone number *

Webcam
YesNo

Email address

Age *

Date of birth *

Place of birth *

Height/weight/hair color/eye color *

Do you enjoy good health? If not please describe health problems

How many days have you missed work due to illness in the past 12 months?

Have you been treated for depression or mental illness in the past 12 months? If yes, please describe the situation and treatment

Have you ever suffered from an eating disorder such as anorexia of bolemia? If yes, please describe the situation and how long ago this was

Do you smoke? If yes, how many sigarettes per day

Would you refrain from smoking in the house, around the children and during working hours?

Do you have any allergies? If yes, specify

Do you have a special diet? If yes, specify

If yes, are you willing and able to prepare your own meals?

If yes, are you willing to prepare meals that you not eat for the family or children?

Do you have a driver's license? If yes, since when?

What kind of vehicle did you drive in the past 12 months?

How often did you drive a car in the past 12 months?

Can you drive a stick shift?
YesNo

Can you drive an automatic?
YesNo

Can you drive in the city?
YesNo

Can you drive in the country side?
YesNo

Would you accept a family with dogs, cats or other pets? If not, please explain

Do you know how to swim?
YesNo

Do you know how to ride a bicycle?
YesNo

Father's nationality and occupation

Mother's nationality and occupation

Ages of brothers and sisters, if any

Do you expect to attend religious services in Holland? If yes, please specify

Any dietary or other restrictions because of your religion. If yes, please specify

Country issuing your passport

Passport number

Level of education reached + year of graduation

Native language

What other languages do you speak, and on what level? (fluent / good / basic)

Would you like to attend Dutch language classes?
YesNo

Other work experience apart from child care/au pair experience (job description, yrs/mnths)

Do you have any criminal convictions?

Describe all your child care experience in as much detail as possible. (period, hours per week, ages of children, duties etc)

Did you take care of children independently
YesNo

Are you prepared to take care of a baby (3 mnths - 1 yr old)? If not, please specify

Experience working with children 1 -3 years old?
YesNo

Experience working with children 4 -7 years old?
YesNo

Experience working with children 8 -12 years old?
YesNo

How many children would you like to work with?
12345+

Do you have any child care qualifications?
YesNo

Have you ever done a first aid course?
YesNo

Do you know how to cook? If yes, what types of food do you usualy cook?

ARE YOU PREPARED TO DO LIGHT HOUSEWORK? Please select below. Please keep in mind that some light housework is required!
YesNo

Laundry

Iron

Picking up after children

Vacuming

Shop for groceries

Prepare dinner

Are there any type of household chores that you do not wish to do?

Do you have interests and hobbies?
YesNo

Like to read

Like to do arts and crafts with children

Like to sing or make music with children

Watch children's videos

Like to horse-play with children

What are your best personality traits?

What are your worst personality traits?

How would you describe your housekeeping style? (neat, more casual, messy etc.)

What type of working and personal relationship would you like to have with your host family?

What do you plan to do after completing your au pair assignment in Holland?

What do you like best about taking care of children?

What do you like least about taking care of children?

What are your favorite activities to do with children?

What do you consider to be appropriate discipline techniques for young children?

In your own words, explain your motivation to become an au pair and what you hope to find in a host family

Earliest possible date of departure (date)

By using this form you agree to the storage and processing of your data through this website.

• Registration Fee SNAPS (€ 34,00)

Amount *
€

Payment methods

• Credit card
• PayPal
• iDEAL

Pay & Register