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					Absolut Au Pairs
20 Clovelly Street
Woodhill Estate
(012) 993 4114



                            ABSOLUT AU PAIRS


AU PAIR APPLICATION FORM                                            DATE __________


PERSONAL DETAILS
First Name & Surname              ___________________________________________
Contact Number/s                  ___________________________________________
Email Address                     ___________________________________________
Residential address               ___________________________________________
                                  ___________________________________________
Date of birth & ID Number         ___________________________________________
Age                               ___________________________________________


Father’s Name                     Occupation of Father               Contact Numbers
___________________               ____________________               __________________
Mother’s Name                     Occupation of Mother               Contact Numbers
___________________               ____________________               __________________
How many siblings in your family? And their ages?
______________________________________________________________________
How would you describe your family?
______________________________________________________________________
How would you describe your relationship with your family?
______________________________________________________________________
Do you regularly attend religious services?    _________________________________
What is your religion?                         _________________________________
Is it important that you have a host family of the same religion?
______________________________________________________________________
Have you ever been charged or convicted of a criminal offence? Give Details:
______________________________________________________________________
Have you ever taken narcotics / non prescription drugs? Give Details:
______________________________________________________________________
Do you suffer from emotional, personality or nervous problems? Please describe
______________________________________________________________________
Can you swim? __________________________________________________________
Do you have a disability? Please describe _____________________________________
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Do you have any allergies? ________________________________________________
Are you on any medication? _______________________________________________
What are your long term goals? ____________________________________________
______________________________________________________________________


Personality
What best describes your personality and lifestyle: (Circle appropriates)
 Positive              Negative                 Outgoing               Shy
 Loud                  Calm                     Athletic               Attentive
 Organised             Creative                 Loving                 Artistic
 Social                Witty                    Messy                  Nature Lover
 Independent           Honest                   Hardworking            Responsible
 Caring                Dependable               Lazy                   Sporty
 Clever                Average                  Fun Loving             Exciting


EXPERIENCE AND SKILLS
What times are you available to au pair?
            Day                     From                          To
            Monday
            Tuesday
            Wednesday
            Thursday
            Friday
            Saturday
            Sunday


What date will you be available from? ___________________________________
What areas would you like to work in? _______________________________________
Would you prefer:         Live-in          Live-out
Would you prefer:         Permanent        Temporary
Would you prefer:         Half-day         Full-day
What is the maximum number of children you would be able to cope with: ___________
I have experience with children aged (circle all that apply)
     0-12 months        1-2yrs         3-5yrs            6-8yrs        9-12yrs        12yrs+
Please provide duties:
     __________________________________________________________________
     __________________________________________________________________
I want to work with children aged (circle all that apply)
     0-12 months        1-2yrs         3-5yrs            6-8yrs        9-12yrs        12yrs+


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Do you have any preference as to sex and ethnicity of the children? Please state:
______________________________________________________________________
Why do you want to be an Au Pair?
______________________________________________________________________
Why do you like these ages? Please be specific:
______________________________________________________________________
Do you have any experience caring for mentally / physically handicapped children? If
yes, please provide the details:
______________________________________________________________________
Do you have experience working with children with ADD/ ADHD, learning or behavioural
problems? _____________________________________________________________
Which of the positions below would you like to apply for: (circle appropriate)
     Au Pair work            Tutoring             Baby sitting          Lifting


CHILDCARE REFERENCES
1.   Family: ___________________________
     Duration: __________________________
     Contact Number: ____________________
     Responsibility: ____________________________________________________


2.   Family: ___________________________
     Duration: __________________________
     Contact Number: ____________________
     Responsibility: ____________________________________________________


DRIVING ABILITY
Do you hold a full drivers licence?                     __________________________
Do you have any endorsements on your licence?           __________________________
Have you ever had an accident?                          __________________________
How often do you drive?                                 __________________________
What car do you drive?                                  __________________________
Is your motor vehicle roadworthy?                       __________________________
Is your motor vehicle insured?                          __________________________


SMOKING
Do you smoke cigarettes? If yes, how many a day?
______________________________________________________________________




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NON SMOKING DECLARATION:
The vast majority of families have strong views on smoking. If you do smoke, but agree
not to in the home of your host family, or when responsible for their children, then tick
YES below. You will be expected to abide by your decision, so consider it carefully.
       YES                   NO


EDUCATION
Have you completed 12 years of school?
______________________________________________________________________
What year did you matriculate and at what school?
______________________________________________________________________
Subjects Completed and Symbols Obtained:
1. ____________________       ______      2. ____________________       ______


3. ____________________       ______      4. ____________________       ______


5. ____________________       ______      6. ____________________       ______


7. ____________________       ______


What is the most advanced educational or professional qualification that you have
obtained?
______________________________________________________________________
What Au Pair Related Qualifications do you have?
______________________________________________________________________
What are your future plans for further education?
______________________________________________________________________


INTERESTS AND HOBBIES
Please circle the areas that best describe your interest and hobbies:
   Swimming                Horse Riding        Cycling               Snow Skiing
   Water Skiing            Snow Boarding       Tennis                Running
   Gymnastics              Writing             Reading               Arts and Crafts
   Musical Instruments     Piano               Guitar                Violin
   Flute                   Choir               Dance                 Photography
   Artwork                 Computers           Community Service


How do you spend your spare time?
________________________________________________________________


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Do you have any other talents or special skills which may be useful when caring for
children e.g. First Aid?
_________________________________________________________________


AU PAIR DUTIES
Would you be prepared to do the following?                        Yes        No
Get children up and ready in the mornings:
Prepare breakfast:
Pack lunches:
Take children to school:
Fetch children from school:
Prepare lunch and/ or snacks:
Take children to extramural activities:
Supervise/ assist with homework/ projects:
Take children on outings:
Prepare dinner for children:
Bath children:
Run errands for family:
Grocery shopping:
Travel with family:


AU PAIR REMUNERATION
Remuneration depends on your experience as well as hours worked per week. As your
agency, Absolut Au Pairs will negotiate the best rate with the family, either as an hourly
rate or a fixed monthly rate. The family will pay this directly to you. As an Au Pair you
can expect a rate between R40 and R50 per hour depending on your experience and
qualifications. These rates do not include travel. Travel could be reimbursed by R2.50
per km. Usually the family would decide to include or exclude a travel allowance. If a
employee should have a temporary placement, he/she will be required to include times
travelled on their time sheets to be reimbursed.


Where did you hear about Absolut Au Pairs? _______________________________




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AU PAIR LETTER
On the accompanying page, write a letter to your prospective family. Include the
following:
      Why you want to be an Au Pair
      Any relevant Childcare experience
      Interests, hobbies and goals for your future
      About your family
      Your personality and characteristics
      What is your definition of a good Au Pair




DECLARATION


I, declare that the information supplied is true and correct.


I understand that it is my responsibility to inform Absolut Au Pairs of any employment,
both temporary and permanent, offered to me by persons (and their agents) to whom I
have been introduced by the agency.


Absolut Au Pairs will not accept any liability for your conduct prior, during or after the
period of employment with the host family. As soon as you are employed by a host
family, the relationship is between the host family and yourself and Absolut Au Pairs is
excluded there from.


Signature of applicant ________________________________


Date and place signed _________________, ____________________




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AU PAIR MOTIVATION LETTER


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