S.C.

EUROLIFE CONSULTING SRL

Calea Plevnei, nr 137C, camera 31, Bucuresti

email:wt@eurolife-consulting.ro
www.eurolife-consulting.ro
Tel/Fax : 0213108369 / 0722925341/ 0747911614

Atasati o
fotografie

REGISTRATION FOR AU-PAIRS

What country do you want to go to?
What is the earliest date you can start?
What is the latest date you ca start?
How long do you want to stay for?

6 month

8 month

12 month

PERSONAL DETAILS
Last name:
Male:

First name:

Female:

Address:
Telephone number at home (including area code):
Telephone number at work (including area code):
Mobile number:
Email address:
Passport Number:
Date and place of
issue:

Expiry Date:

Date of birth:

Place of birth:

Nationality

Religion:

Height:

Weight:

Colour of hair:

Colour of eyes:

Do you have any visible body piercing or tattoos? If so,

where and what?
Do you regularly attend religious services?
Fathers name and
profession:
Number of Brothers:
Number of Sisters:

Yes
Mothers name
and profession:
Age:
Age:

No

24 month

EDUCATION
High School Name:
Location:

Profile:

Date from:

Date to:

University Name:
Location:

Faculty Name:

Date from:

Date to:

Do you want to take any language or educational

courses in the host country?
Do you have knowledge of first aid or life-saving?
If so, do you have any certificates?
Have you taken any courses relating to childcare?
If so, what?

No
No

.
Yes .
Yes .

No

Yes

LANGUAGES
What is your mother tongue?

Do you speak English?

Is your English:
Do you speak any other languages?
Please list languages spoken and level of
competence:

No

Fluent

Good

No
Fluent

Good

Fluent

Good

Fluent

Good

Yes
Average

Yes
Average

Basic

Poor

Basic

Poor

1)
2)
3)

Average

Average

Basic

Poor

Basic

Poor

CHILDCARE EXPERIENCE AND REQUESTS

What experience do you have with children?
What ages do you have experience of?

What age do you prefer to care for?

Would you like to be placed with a family with
Are you willing to care for a disabled child?
Do you have any experience of caring for a disabled
child?
If so, what experience do you have?
Would you accept a family without children?
Would you help with a new born if the mother is
present?
Would you help to look after the elderly?

0-2

2-6

6-10

10-14

Over 4

No
No

No
No
No

14-18

Yes
Yes ...

Yes
Yes
Yes

DOMESTIC EXPERIENCE
Can you cook?
Can you do washing and ironing?
Can you vacuum and dust?
Are you prepared to help with light domestic work?
(Most families require this)

No
No
No
No

Yes
Yes
Yes
Yes

PETS
Do you like pets?
Are you happy to live in a family who have pets?
If so, would you help to look after them?
Are you allergic to any animals?
Are there any animals you do not like?

No
No
No
No
No

Yes
Yes
Yes
Yes ..................................................
Yes

HEALTH
Do you have any allergies?
Are you in good health?
If no, please explain:

Yes
No

..................................................
No ..................................................

Yes

HOBBIES, SPORTS AND SPECIAL SKILLS

What are your hobbies?
If yes, please explain:
Do you participate in any sports?
If yes, please explain:
Can you swim?
Do you have a background in music or dance?
Do you play any musical instruments?
Do you have any special skills, such as horse-riding,
sailing etc?

No
No
No
No

..................................................
Yes ..................................................
Yes ..................................................
Yes ..................................................
Yes

DRIVING
Do you have a current driving licence?
When did you get your licence?
Do you drive regularly?

No
Daily

Are you prepared to drive in the host country once you

get to know the area?

No

Yes
..................................................
Once a week
Occasionally

Yes

SMOKING
Do you smoke?
If so, how many per day?
Could you refrain from smoking in the familys house or
in front of the children?

No
No

..................................................
Yes
Yes

AREA PREFERENCES AND SPECIAL REQUESTS

Would you prefer to be in a..?

city/town

Would you accept one-parent family?

If yes, please specify.

No
No

Are you willing to work with families of all ethic and

religious backgrounds?

No

If we cannot find you a family in that area, would

you be prepared to consider other areas?

village/countryside

Yes
Yes ,
Yes

any area

mother father

TRAVEL EXPERIENCE
Have you travelled to any other countries before?
If yes, please specify.
Have you lived away from home before?
If yes, please specify for how long.
Have you been to the host country before?
For what purpose?
Do you have a boyfriend/girlfriend?
If yes, does he/she agree on you being an au pair?

..........
Yes ..........
Yes tourist
for work
au-pair

No

..........
Yes

No
No
No

No

Yes

Yes

Why do you want to be an au pair and why have you chosen the host country?
..
..
..
..
..
..

I CONFIRM that I have understood all questions, answered them honestly and all information in the application is
true. By sending it to S.C. EUROLIFE CONSULTING SRL I declare my intention of becoming an au-pair and I
apply for the Au-Pair Program presented to me by S.C. EUROLIFE CONSULTING SRL. I declare that I will provide
(send) the other documents requested by S.C. EUROLIFE CONSULTING SRL to complete my application
documents; I will respect all the terms and deadlines established together.

Signature

Date ..