Calle Teruel 41, Esc. 1, Bajo B
28020 Madrid, Spain
Tel.: + 34 629 148 478
http://www.planetaupair.com/

Office hours: by appointment only.


AU PAIR USA APPLICATION FORM

(All information is confidential and will not be shared with anyone other than Planet Au Pair, Expert Au Pair and host families). Please fill out every section. After reviewing your application, we will contact you for an interview.  
 

Name__________________________________________________________________
         Family                                               First                                                         Middle

Address:______________________________________________________________

_____________________________________________________________________

Telephone________________________ Fax ___________________________

Email:___________________________

Skype ID: _______________________

Date of Birth___________  Religion_______________  Nationality________________

Height______  Weight______  Sex___  Occupation____________________

Previous occupation(s):_______________________________________________________

_________________________________________________________________________
Name, address and phone number of next of kin in case of emergency:

_______________________________________________________________________

________________________________________________________________________

Father's occupation___________________ Mother's occupation__________________

Brothers and sisters and their ages: _____________________________________________

When did you leave school? ______________ Qualifications___________________________

What are your career plans?___________________________________________________

English proficiency level:  Excellent ____Good ____Fair ____Poor ____None __

Do you speak any other languages and at what level?__________________________

Do want to attend language classes?___________________

What is your experience with children and their ages:______________________________

______________________________________________________________________

______________________________________________________________________
 

What are your interests, hobbies and child care related activities you can/would undertake ?

______________________________________________________________________

______________________________________________________________________

Are you an animal lover?_______________ Do you have a full driver's license?_____
Have you ever been away from home and,  if so, why, when and for how long?

______________________________________________________________________

______________________________________________________________________

Do you understand that you will be expected to help with the child care related light housework?______ 

Do you smoke?_____ If you smoke, would you be willing to smoke only outside of your host's home?_____

Do you understand that if you smoke against your host's wishes, they are completely within their rights to ask you to leave?_____

Do you have any health problems?_____  Allergies?_____  Criminal record?_____

What ages of children do you prefer?___________  Do you like babies?______

How many children are you willing to look after?_______________

Do you wish to be placed near friends or relatives? If so, please give details____________

_____________________________________________________________________

When do you wish to be placed?__________________ (Not guaranteed)

I, the undersigned, confirm that all the information provided above is true. 

Signed_________________________________ Date__________________

How did you hear about us?______________________________________________
Additional comments:

 

 

 

 

CONDICIONES ADICIONALES AL CONTRATO AU PAIR

La candidata perderá todo derecho a reclamación si unilateralmente tomase la decisión de abandonar la familia o de volver a España o su país de origen.

La reclamación sobre la familia debe ir dirigida a la oficina correspondiente en el país de destino, o, en el caso que Planet Au Pair hace la colocación, deber ir dirigida
a Planet Au Pair. Estudiarán las causas del problema procurando la resolución sobre la familia o la posibilidad de cambio de familia.

En el supuesto de que la candidata no sea admitida en el país de destino, o una vez admitida sea devuelta de allí por orden de la autoridad, Planet Au Pair declina toda responsabilidad al respeto.

Acepto que Planet Au Pair actúa meramente como intermediario entre la familia en el país de destino y yo y queda exonerado de cualquier responsabilidad legal y económica; estas, naturalmente, corresponden a la familia asignada en su caso.

No se garantiza fechas de estancia o fecha de comienzo de estancia, ni ciudad ni provincia.

La documentación no se devolverá a la interesada.

LEÍDO Y CONFORME

NOMBRES Y APELLIDOS __________________________________________________


FIRMA _________________________________________________  Fecha ___________