Au Pair Application Form

Application Form For Au Pair

Please send the information below by e-mail to info@lighthouse.ee.

I would like to work as Au Pair in

______

Name

______

Address ( country, city, zip code, street, ect. )

______

Phone / Fax

______

E-mail (double check!)

______

Citizenship

______

Civil life

______

Do you have brothers / sisters, if yes what age

______

Do you have any experience with children, if yes what age were they at that time

______

Do you have a driving licence, if yes from what time

______

Do you have criminal record

______

Do you smoke

______

When you can start your work

______

Education

Basic school (1-9)

______ what year ______

Basic school (1-3)

______ what year ______

College

______ what year ______

Other education

______ what year ______

Profession (have you worked before)

______ if yes, where  ______

Have you worked as Au Pair before, if yes where and how long time

  ______ in ______

Do you have any references from those families or others which know you well

______ from : ______

Are you allergic against something

______ if yes what :  ______

What child diseases have you had

______ specify which  ______

Have you any serious sickness lately

______ if yes what : ______

Which languages do you speak

______

I would be interested in language course to better my :

______

Tell us about your hobbies

______

How many children are you able to take care off in you hostfamily

number of children ______ what ages ______

Are you able to send us your medical sertificate if family require that

______

Can you swim

  ______

Are you vegetarian

  ______

Do you like pets

  ______

have you worked with handicap children

  ______

Dou you accept a single parent

  ______

Are you registered in some other agency now

  ______

Additional comments ( if any )

  ______

______ ______