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application form - au-pair australia and new zealand

* (star) = mandatory field

about you

select your country:australia: new zealand:
* first(given)name:
* surname:
sex:female: male:
date of birth:
residential address
* telephone number:
mobile/cell telephone number
* e-mail address:
nationality:
country of birth:

travel details

do you have a current valid passport?:yes: no:
which country do you plan to visit?:
have you applied for a visa?:yes: no:
type of visa applied for:working holiday: student:
temporary resident: tourist:
permanent resident:
when can you start?:
how long can you stay?:

employment history

please describe your experience caring
for children, and any formal Childcare Qualifications
what were their ages?
what is your most recent occupation?:
please detail your employment history
do you have written references?:yes: no:
what are your hobbies and interests?

skills

what is your ability to speak english?:poor: good: fluent:
please list other languages spoken
are you planning to study whilst visiting
your country of choice?:		 yes: no:
if yes, at which college(s)?:
course/subject(s):
how many hours study per week?:
please list study timetable

driving

can you drive a car?:yes: no:
are you able to drive a manual transmission?:yes: no:
are you able to drive an automatic transmission?:yes: no:
do you hold a valid driving licence?:yes: no:
do you hold a valid international drivingyes: i intend to apply:
licence?:no: i do not intend to apply:
have you had any accidents?:yes: no:
if "yes", list the date of all accidents, describe what happened, and details of
any disqualification

personal information

what is your religion? please describe
any religious needs
do you have any illnesses or allergies?:yes: no:
if yes, please provide details
are you taking any medication?:yes: no:
if yes, please provide details
do you have a special diet?:yes: no:
if yes, please provide details
do you smoke?:yes: no:
do you drink alcohol?:yes: no:
can you cook?:yes: no:
will you cook for children?:yes: no:
will you cook meat for children?:yes: no:
will you do light housework?:yes: no:

please indicate if you have any of the following:

multiple earrings:yes: no:
nose stud:yes: no:
nose ring:yes: no:
tongue stud:yes: no:
eyebrow stud:yes: no:
visible tattoo:yes: no:
dreadlocks:yes: no:

application

preferred position with host family:Au Pair live-in: Nanny live-in:
Nanny live-out: Housekeeper:
preferred contact method:telephone: e-mail:
do you consent to your application profile and photograph being forwarded to prospective host families?:yes: no:

confirmation

full name:
this information is true and correct:
date of application:
secure code :
please type in the secure code:
please be aware of upper and lower case