! 1124 Budapest, Frj u.

2
+361/235-0889
+3620/772-1312

Application Form

Passport photo

General Information:
Preferred country: _____________________________

Surname/Family name: _________________________

First name/Given name: _________________________

Address: ______________________Town: _____________

Postal code: _____________ Nationality: ________________

E-mail: ________________@_______________________

Address of parents: _________________________________

Mobile phone: +36_____________ Land phone: ___________

Date of birth: _________________Nationality: ___________

Marital status: ___________ Sex: Male Female

Occupation of father and mother: _______________________

Brother(s), sister(s) ages: _____________________________

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 ! 1124 Budapest, Frj u. 2
+361/235-0889
+3620/772-1312

Earliest date I could depart: ___________________________

Latest date I could depart: ____________________________

Length of stay: ____________________________________

Which area do you prefer? ____________________________

country small town city

Would you like to attend to a language school? Yes No

Do you smoke: Yes No

Could you refrain from smoking in the house of the host family? Yes No

Do you have a driving licence? Yes No Since when? _________

Are you a vegetarian? Yes No

Do you suffer from allergies? Yes No

Do you accept living with pets? Yes No

If not, why?

_____________________________________________

Education: _____________________________________________

Have you ever been in conflict with the law? If yes, please explain:
_____________________________________________________

Languages:
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 ! 1124 Budapest, Frj u. 2
+361/235-0889
+3620/772-1312

What is you mother tongue? _________________________________

Knowledge of languages: Good Sufficient Poor None

English
French
German
Spanish
Italian
Dutch
Other: _____________

Child Care Experience:

List name and age of children you cared for. What were your responsibilities?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Have you taken any course related to childcare? If yes, where?

Yes: _______________________________ No
Do you have any other talents or skills which may be useful when responsible
for children? E.g.: first aid, life saving?
_____________________________________________________
_____________________________________________________

Please describe your hobbies, interests and sports:

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 ! 1124 Budapest, Frj u. 2
+361/235-0889
+3620/772-1312

_____________________________________________________
_____________________________________________________

Would you like to be place in a family with children at the age of:
new born until 6 months 3 years old 8 and 9 years old
7 months 12 months 4 and 5 years old 10 and 11 years old
1 and 2 years old 6 and 7 years old older then 12 years

Would you prefer to be placed in a family with 1, 2, 3, 4 or 5 children? _____

I declare that all the information given on this form is correct to the best of
my knowledge and I enclose a recent medical certificate. I understand that I
am responsible for my own travel expenses.

Signature of applicant: _________________ Date: __ /_______ /2017

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