Au Pair Application USA

Συμπλήρωσε την παρακάτω online φόρμα συμμετοχής. Στην συνέχεια θα επικοινωνήσουμε το συντομότερο μαζί σου σχετικά με τα επόμενα βήματα και τα απαιτούμενα έγγραφα της αίτησής σου.

Applicant Information - Step 1 of 9

Name *

First

Last

Email *

Confirm Email

Phone

Skype:

Address:

Date of birth:

Σημείωση: Το όριο ηλικίας συμμετοχής είναι τα 26 έτη, ως εκ τούτου δεν είναι δυνατή η αίτηση από άτομα μεγαλύτερης ηλικίας.

Nationality:

City and country of birth:

Eye color:

Amber
Black
Blue
Brown
Green
Hazel
Silver

Natural hair color:

Auburn
Black
Blonde
Brown
Chestnut
Red

Have you ever applied for a visa to the USA?

What was the outcome?

Denied
Approved

Have you ever travelled outside of your home country before?

Where did you travel to?

Have you been an au pair in the USA before?

Have you ever been an Au Pair in a country other than USA?

Have you visited the USA before?

Have you ever lived abroad before?

Gender

If given the opportunity, would you consider extending your stay in the US*:

Yes
No
Maybe
I don’t know

If yes, for how long (months):

6 months
9 months
12 months
I don’t know

Notice Required at work:

Preferred departure airport(s):

Your nearest US Embassy:

Earliest departure date:

Latest departure date:

Emergency Contact Name:

Relationship to you:

Email:

Phone:

Emergency contact primary language:

Child care experience summary

Your chances of being placed with a family will greatly improve if you are willing to care for two or more children and if you are willing to care for children younger than two years of age.

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

Experience with children ages:

Newborn - 2 year
2 - 6 years
6 + years
Caring for 2 or more children at the same time

Willing to care for children ages:

Newborn - 2 year
2 - 6 years
6 + years
Caring for 2 or more children at the same time

Tell us more about your skill

General Childcare

Please describe all the ways in which you have gained your child care experience

Please describe all the ways in which you have gained your child care experience:

Au pair
Summer activity camp
Babysitting, full time
School teacher
Tutoring children
Day care center for children
Caring for younger family members
Youth or church group/club
Nanny
Babysitting, evening
Babysitting, daytime
Support school teacher
Coaching children’s sports
Teaching after school activities
Music teacher
Other*

*Please describe:

Older than 2 years of age

I have experience in these areas caring for children older than 2 years of age

Putting to bed
Teaching or tutoring
Doing arts and crafts projects
Playing outdoors
Dealing with tantrums
Assisting with homework
Playing indoors
Potty training
Bathing
Other*

Under 2 years of age

I have experience in these areas caring for children 0 – 2 years of age

I have experience in these areas caring for children 0 – 2 years of age:

Preparing baby formula (milk)
Feeding a baby with a spoon/fork
Putting a baby to bed
Playing with and involving baby in age appropriate activates
Changing a diaper
Feeding a baby with a bottle
Bathing a baby
Burping a baby
Dealing with tantrums
Caring for a colicky baby

*Please describe:

Do you have a driver’s license?

Do you own your own car?

How many years have you had a full driver's license (including practical and theory test)?

What date was your license issued on? *

What kinds of roads do you usually drive on?

City
Country
Highway

Have you ever driven with children in the car?

What types of cars are you used to driving?

Four Door
Minivan
Motorcycle / Scooter
SUV
Two Door

Do you have experience driving a vehicle with a (please select all that apply): *

Automatic Transmission
Manual Transmission

Are you willing to drive in the US as an au pair?

Do you feel comfortable driving on roads with snow?

Yes
No
I don't know

Have you ever had a car accident?

Have you ever had a speeding ticket?

Rate your driving skills:

Excellent
Good
Fair
Poor

How often do you drive?

Daily
Several times a week
Several times a month
Less often

Education

Languages:

English comprehension ability :

Poor
Fair
Good
Very Good
Excellent

English spoken ability :

Poor
Fair
Good
Very Good
Excellent

English written ability :

Poor
Fair
Good
Very Good
Excellent

What grades/scores did you achieve at secondary school?

Average
Good
Low
Medium
Not applicable
Top

Have you gone beyond secondary education?

What did you study?

Please describe the type of education you have beyond secondary school:

Other
Technical Courses
University

Occupation History

Please tell us about your work history. What do you currently do for a living? What other jobs have you held? Please list all of your duties and responsibilities for each job listed.

What is your current occupation?

Employed
Recent Graduate
Student
Un-Employed

Give a brief summary of jobs you have held, duration and duties (including part time and summer vacation jobs):

Future plans

Please tell us what your plans are for the future, this includes long-term career goals and plans for what you want to do after you complete the au pair program.

What are your long term career goals?

What do you plan to do after the au pair program?

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

If yes, explain:

Describe your swimming skills:

Excellent
Good
Fair
Poor
I can’t swim

I have experience doing following household chores:

Cooking
Folding clothes
Light cleaning
Baking
Tidying up
Vacuuming
Ironing
Laundry

Describe any skills/participation in the following areas (including past and current hobbies and interests)

Cooking
Photography
Writing
Design
Gardening
Handicrafts

Music

Musical Instrument
Singing
Reading Music

Outdoor

Camping
Soccer
Swimming
Hiking
Sailing
Jogging
Girl scouts
Skiing

Other (computers, travel, board games, reading etc.):

Your living arrangements

Please tell us more about your home life. Do you have pets? What kind of area do you live in? Have you ever lived away from your home?

What pets have you had or currently have?

Bird(s)
Cat(s)
Dog(s)
Fish
None
Other large outdoor pets (e.g Horses / Goats)
Reptiles/Amphibians
Small pets (e.g Hamster / Rabbit)

What word best describes where you live?

Farm
Large city
Rural area
Small city
Suburban
Town/Village
Urban

Where are you currently living?

Alone
Dorm
Roommate
Significant other
With parents

How many years have you lived away from home?

Ages and names of siblings:

What is your religion?

How often do you attend church/temple?

Daily
Never
On Special Occasions
Weekly

What are your favorite things to do in your spare time?

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

Please describe a typical evening during the week:

Please describe a typical evening during the weekend:

Why do you want to participate in the au pair program?

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

Have you been a victim of physical, sexual or emotional abuse?

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

Do you take any medication?

Have you received treatment for an emotional problem (e.g. anorexia, depression)?

Do you have allergies or fears of household pets?

Do you have food allergies?

Do you follow a special diet?

If yes on any, please give details:

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

If yes, please give details:

Do you smoke?

If yes, cigarettes per day:

Are you willing to quit smoking?

Do you agree to follow the host family’s rules for smoking?

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?

Agreement *

Έχω διαβάσει και συμφωνώ με την πολιτική απορρήτου και τους όρους και τις προϋποθέσεις της Anixi.

Name *

First

Last

Date *

Comment