Full Name *

First

Last

Email *

Email

Confirm Email

Date of birth:

Phone

Best time to call:

Skype:

Do you have WhatsApp?

Yes
No

Do you have FaceTime?

Yes
No

I’m applying to be an au pair in:

Gender

Emergency Contact Name:

Relationship to you:

Email:

Phone:

Does this person speak English?

Yes
No

How long would you like to stay:

Earliest starting date:

Latest starting date:

Απαιτούνται 2 συστάσεις από μη συγγενικά πρόσωπα οι οποίες αφορούν ενασχόληση με παιδιά.

Παραδείγματα πρακτικής εμπειρίας που μπορούν να έχουν οι συμμετέχοντες: • Babysitting σε οικογένειες • Εργασία σε παιδότοπο • Εργασία σε παιδικό σταθμό • Πρακτική σπουδών • Ομαδάρχης σε κατασκήνωση • Ομαδάρχης σε προσκόπους • Ιδιαίτερα μαθήματα σε παιδιά • Εργασία με παιδιά σε προγράμματα εθελοντισμού • Μαθήματα γυμναστικής, μουσικής κ.α

Number of children (the more flexible you are the more options you will have):

Do you have a driver’s license?

Yes
No

How long have you had a full driver’s license (including practical and theory test)?

Rate your driving skills:

Excellent
Good
Fair
Poor

How often do you drive?

Daily
Several times a week
Several times a month
Less often

Have you gone beyond secondary education?

Yes
No

What is your current occupation?

Language Knowledge

Other:

Do you have formal safety training or certificates (e.g. First Aid, water safety):

Yes
No

Currently living:

With my parents
On my own

Ages and names of siblings:

Father’s profession:

Mother’s profession:

Religion:

Do you attend church/temple?

Yes
No
On Special Occasions

Have you traveled outside your home country for 2 months or more?

Yes
No

Have you been convicted of or charged with a criminal offence?

Yes
No

Do you have chronic/recurring health problems (e.g. asthma, diabetes, depression)?

Yes
No

Do you have food allergies?

Yes
No

Do you follow a special diet?

Yes
No

If yes on any, please give details:

Do you have any condition that could affect your performance as an au pair:

Yes
No

If yes, please give details:

Would you accept a single parent family?

With a single mother
With a single father
No

Would you accept a family with pets?

Yes
No

Do you smoke?

Yes
No

Do you want to be in contact with other au pairs and do you agree that your email is given to other au pair participants?

Yes
No

Date *