AU PAIR IN SPAIN - APPLICATION FORM.cdr

AU PAIR IN SPAIN - APPLICATION FORM.cdr

NL
SOLICITUD - APPLICATION FORM
aupair en españa - au pair in spain
Avda. Eduardo Dato 23, Local Interior - 41018 Sevilla
Tel 902 884 051 | [email protected]
LENGTH OF YOUR STAY ___________________________ STARTING ________________________
DATOS PERSONALES - Personal Details
NOMBRE - Name ________________________ APELLIDOS - Surnames __________________________________
DIRECCION - Address _____________________________________________________________________________
CIUDAD - City ________________________________ CODIGO POSTAL - Post Code ________________________
TELEFONO - Tel. Number ________________________________ FAX ______________________________________
E MAIL ____________________________________________________________________________________________
FECHA DE NACIMIENTO - Date of Birth ___________________________ EDAD - Age ______________________
RELIGION ____________________ PESO - Weight _________________ ESTATURA - Height _________________
INFORMACION DE TU FAMILIA - Family Information
NOMBRE Y OCUPACION DE TU PADRE - Father’s Name and Occupation ______________________________ | ________________________
NOMBRE Y OCUPACION DE TU MADRE - Mother’s Name and Occupacion _____________________________ | ________________________
DIRECCION Y TELEFONO DE TUS PADRES (SI ALGUNO DE ESTOS DATOS ES DISTINTO AL REFLEJADO ARRIBA)
Parent’s address and tel. Number (if different to the information given above) ___________________________________________________
_____________________________________________________________________________________________________________________________
EDADES DE TUS HERMANOS Y HERMANAS - Brother’s and Sister’s ages _________________________ | ____________________________
INFORMACION ACADEMICA Y GENERAL - Academic and General Information
ESTUDIOS TERMINADOS - Educational Background ____________________________________________________________________________
CURSOS COMPLEMENTARIOS - Other courses ________________________________________________________________________________
CONOCIMIENTOS DE ESPAÑOL - Knowledge of Spanish
NADA
None
BASICO
Basic
INTERMEDIO
Intermediate
BUENO
Good
MUY BUENO
Very Good
¿AÑOS DE ESTUDIO? - How long have you studied Spanish? _____________________________________________________________________
¿HABLAS OTROS IDIOMAS?¿CUAL/ ES? - Can you speak other languages? Which one/s? __________________________________________
¿TIENES ALGUNA EXPERIENCIA LABORAL? DETALLALA - Did you work in the past? Please give details
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
¿SABES CONDUCIR? - Can you drive? ________________ ¿DESDE CUANDO? - Since when? _________________________________________
¿ACEPTARIAS CONDUCIR EN EL PAIS DE ESTANCIA? - Would you accept to drive during your stay’ _______________________________
INFORMACION ACADEMICA Y PERSONAL - Academic and General Information
¿TE INTERSARIA IR A CLASES? - Would you attend Spanish classes? _________ ¿ACEPTARIAS COCINAR? - Could you cook? _______
¿SABES NADAR? - Can you swimm? ___________ ¿ALGUN CURSO DE PRIMEROS AUXILIOS? - Any First Aids courses? ______________
AFICIONES - Hobbies
BRICOLAJE
Do it Yourself
JARDINERIA
Gardening
FOTOGRAFIA
Photography
TEATRO
Theatre
CINE
Films
NAVEGAR
Sailing
NATACION
Swimming
TENIS
Tennis
CAMINAR
Walking
BICLETA
Cycling
OTROS - Others ________________________________________________________________________________
EXPERIENCIA CON NIÑOS - Childcare Experience
RESEÑA TU EXPERIENCIA CON NIÑOS - Please give details about your experience with children
RECIEN NACIDOS
New Borns
DE 1- 2 AÑOS DE EDAD
From 1 - 2 years old
DE 2 - 5 AÑOS DE EDAD
From 2 - 5 years old
DE 5 - 10 AÑOS DE EDAD
From 5 - 10 years old
MAS DE 10 AÑOS
Over 10 years old
DISCAPACITADOS
Disabled children
¿POSEES ALGUNA TITULACION ESPECIFICA? - Do you have any training/qualifications for children? _______________________________
¿HAS SIDO AU PAIR CON ANTERIORIDAD? SI ASI FUESE, POR FAVOR DA DETALLES - Have you been an au pair before? If so, please
give details
_____________________________________________________________________________________________________________________________
PREFERENCIAS - Preferences
¿ACEPTARIAS ....? - Would you accept ....?
UNA FAMILIA CON ANIMALES DOMESTICOS? - A family with pets?
SI - Yes
NO - No
UNA FAMILIA SIN PADRE? - A single Mother Family?
SI - Yes
NO - No
UNA FAMILIA SIN MADRE? - A single Father Family?
SI - Yes
NO - No
VIVIR EN … - To live in a ....
CIUDAD - City
EXTRARRADIO - Suburb
PUEBLO - Town
ALDEA - Village
CAMPO - Countryside
INDIFERENTE - No preference
SALUD - State of Health
¿ALGUNA ALERGIA? SI ASI FUESE DA DETALLES - Any alergies? If so, please give details ________________________________________
¿ALGUNA DIETA? SI ASI FUESE, DA DETALLES - Any diet? If so, please give details ______________________________________________
¿TOMAS ALGUN MEDICAMENTO? SI ASI FUESE DA DETALLES - Any specific medication? If so, please give details ________________
¿FUMAS? - Do you smoke?
SI - Yes
NO - No
¿CUANTOS AL DIA? - How long per day? ___________________
¿ACEPTARIAS FUMAR SOLO FUERA DE CASA? - Would you accept to smoker outside the house? _________________________________
OTRAS IMPORTANTES CUESTIONES - Another important questions
¿POR QUE HAS DECIDIDO SER AU PAIR? - Why did you decide to be an au pair? _______ ________________________________________
¿HAS VIVIDO ALGUNA VEZ FUERA DE CASA DE TUS PADRES? - Have you ever lived away from home? If so please give details
___________________________________________________________________________________________________________ ________________
I agree with the general conditions of this Au Pair Programme. I confirm all the details I am including are correct. I understand my
responsibilities with the family is going to invite me. I declare I am a single person, I am not pregnant I don’t take drugs. I understand
that NuevasLenguas provides an introduction between myself and a family and is not liable under any circumstances for any loss,
damage or expense incurred by me.
Fecha / Date _________________________ Firma / Signature _________________________________________________________________________
Passport Number _________________________________________ Valid until ____________________