House o'Orange Basic Au Pair and Nanny application

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					House o'Orange: Basic Au Pair and Nanny application
If you're interested in a placement through House O Orange Au Pairs Please send us your application by submitting
this form. Once we've screened your application we will contact you a.s.a.p. All questions are mandatory.

First name:
Last name:
Date of birth:
Country issuing your passport:
Gender:
Current mailing address:
City:
Country:
Daytime phone no.:

Nighttime phone no.:
Current e-mail address:
Available from:                                                                                        Month/year
Until:                                                                                                 Month/year
Smoker:                                                             O Yes O No O Will not smoke in the house
Driver:                                                             O Yes       O No
Native language:
Level of English:
What other languages do you speak?
Do you have any formal childcare training?                          O Yes       O No
If yes, please specify:


Please list your babysitting and other childcare experiences and
include ages of children:
Are you looking for a live-in/live-out position?                    O Live-in   O Live-out
Are you looking for an au pair or a nanny position?                 O Au pair   O Nanny
Is there specific part of Holland that you would like to work in?   O Yes       O No

If yes, please specify:


What age group (children) do you feel most comfortable with?
Please list some of your hobbies and interests:



Thank you for your interest in House O Orange Au Pairs!
Please send this form to :

House O Orange Au Pairs
Ellen Heesen-Hiemstra
Oostduinlaan 115
2596 JJ The Hague