international au pair italy

!!!!!Au Pair Application form

!

First&name& Soa

Family&name Berrotarn

Country&requested? Italy

Earliest&departure&date? 15h&December Latest&departure&date? 1st&January

How&long&can&you&stay? 1&1/2&G&2&months

Do&you&prefer&a&family&in: A&big&city&preferably. &&

Complete&address Juramento&1733&5&A

Telephone&N&(with&code) I&dont&use&it Mobile&N(with&code) 5491158525632

EGmail [email protected]

Skype&contact soa.berrotaran

Date&of&birth 3rd&June&1994 Place Buenos&Aires,&Argen]na

Age 20 Na]onality Italian/Argen]nean

Marital&status Single

Cod.&Fisc.

Height 168cm Weight 58kg

Are&you&a&smoker&? NO

Are&you&a&driver&?& YES

How&many&years&have&you&been&studying&English? 17

What&is&your&religion? Atheist Im&openminded&anyways.

Do&you&have&previous&experience&in&childcare? YES

Previous&and/or&current&occupa]ons I&worked&at&a&daycare&and&Im&currently&a&student&at&university.

Have&you&completed&12&years&of&schooling? YES

! 1! Via dei Platani, 100 20020 Arese Milano Italia

Fax: +390293580439 Tel: +393497946488

www.internationalaupairitaly.com E-mail: [email protected]

!!

Studies&performed High&school,&piano&degree&at&music&conservatory,&currently&4th&

year&at&a&5&year&degree&in&music&at&university.

Do&you&have&any&future&plans&for&further&educa]on? Finishing& my& music& degree& and& star]ng& my& ini]al& educa]on&

degree&to&work&in&kindergartens.

Parents&occupa]on Mother& owns& a& factory& and& it's& a& chef,& father& is& a& horse&

veterinarian.

Brothers&and&sisters&(name&and&age) Brother:&Pablo,&19&years&old.&Studies&engineering&at&university.


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!!Please&circle,&underline,&highlight&or&bold&the&words&that&best&describe&characteris]cs&of&your&personality&and&lifestyle&and&then&list&

below&any&other&of&your&dominant&quali]es.&

!

& & &

neat aeen]ve messy honest clean

nega]ve organised nature&lover sensi]ve crea]ve

mature caring hard/working wi2y responsible

ar7s7c calm shy mature& dependable

loud posi7ve Open/mind athle]c indipendent/

Do&you&presently&have&a&serious&boyfriend&or&girlfriend? YES

Explain&how&you&will&cope&with&homesickness&when&away&from&your&boyfriend/girlfriend&for&up&to&12&months?

Ive&already&spent&3&months&away&from&my&boyfriend&when&I&worked&in&Budapest&and&while&he&worked&in&the&USA.&I&think&we&live&in&a&]me&were&we&can&make&the&best&of&technology&and&communica]on&and&we&have&Skype&to&chat&even&though&were&very&far&apart.&Thats&how&we&coped&with&the&separa]on&the&last&]me.

Foreign&languages:

English& O/Fluent/C1=C2 O&Good&B2 O&Fair&B1 O&Liele&A2 O&None&A1

French O&Fluent O&Good O/Fair O&Liele O&None

Spanish O/Fluent O&Good O&Fair O&Liele O&None

German O&Fluent O&Good O&Fair O&Liele O/None

Italian O&Fluent O/Good O&Fair O&Liele O&None

How&long&have&you&been&studying&English?&17&years

Did&you&study&another&language?&French&(since&2013&and&ongoing)&and&Italian&(throughout&high&school)

Have&you&ever&been&abroad&before? YES

If&Yes,&in&which&countries? Hungary& for& two&months,&USA&for&2&months,&several&countries&

of&Europe&for&couple&of&days/weeks,&Chile&and&Uruguay.

Have&you&ever&lived&on&your&own? Yes,&while&I&worked&in&Budapest,&for&two&months

Do&you&wish&to&aeend&a&language&course,&when&abroad? No,& I& already& have& a& good& level& and& I& wish& to& improve& it& by&

conversa]on.

Do&you&smoke?& & & NO&&


Fax: +390293580439 Tel: +393497946488


!!If&yes,&how&many&cigareees&per&day?

Would&you&accept&to&smoke&only&outside&the&house? O&Yes& &&&&O&No&&


Fax: +390293580439 Tel: +393497946488


!!Do&you&hold&a&driving&licence?&& YES

Are&you&willing&to&drive&abroad? YES

If&yes&,&date&passed&of&the&driving&licence: Automa]c&drive:& &&&NO

Manual:& &YES

Have&you&ever&had&an&accident: NO

How&ohen&you&drive: Several&]mes&a&week

What&condi]ons&do&you&have&experience&to&drive&in?&Please&circle&which&applies:

City Hightway Rural Snow

Night Wet Right&hand&drive LeC/hand/drive

Do&you&have&special&diet,&allergies&etc?&& NO

Do&you&have&any&dietary&restric]ons? NO

Are&you&vegetarian? NO

If&yes,&please&indicate&if&you&are&prepared&to&live&with&a&family&

who&is&not,&and&if&you&are&prepared&to&handle&meat.

YES

Do&you&drink&alcohol?:&YES How&ohen?:&Only&socially,&once&or&twice&a&week.

Do&you&like&animals? YES,&a&lot.&

Have&you&ever&been&an&au&pair&before? NO

If&yes,&in&which&country&and&for&how&long?

Would&you&like&to&be&placed&as: Whatever&is&available&related&to&childcare.

How&much&experience&do&you&have&with:

looking&aher&children&aged&&0G2 Good Some None

looking&aher&children&aged&&3G7 Good Some None

looking&aher&children&aged&8G12 Good Some None

looking&aher&disabled&children Good Some None

keeping&children&occupied&(play&with&them) Good Some None

doing&light&housework Good Some None

washing/ironing&clothes Good Some None


Fax: +390293580439 Tel: +393497946488


!!!!!

cooking&simple&meals Good Some None

looking&aher&pets Good Some None

Which&ages&of&children&do&you&like&best? From/1/to/7

But&I&dont&really&mind.

Are&you&ready&to&take&care&of&disabled&children? NO

Would&you&accept&a&single&parent&family? EITHER

Would&you&accept&a&family&with&a&dierent&religion? YES

Your&hobbies&or&interests: Playing& the&piano,&singing,&dancing,& reading,&watching&movies,&

travelling&and&hanging&out&with&friends.

Can&you&swim? YES

Do&you&like&sports? YES

If&yes,&which&ones? Tennis,&handball,&horse&riding&and&skiing.

Have&you&ever&been&charged&or&convicted&of&a&criminal&oence? NO

Have& you& been& hospitalised& or& under& the& care& of& a& doctor&

within&the&last&12&months?

NO

Do& you& have& any& chronic& or& recurring& health& problems& eg&

asthma,&diabetes,&cold&sores?

NO

Would&you&agree&to&undergoing&a&test&for&aids/HIV? YES

Do&you&have&any&allergies(include&pets)? NO

Please,&rate&your&top&ve&reasons&for&wan]ng&to&be&an&au&pair/nanny,with&ONE&being&the&most&important&reason,&and&FIVE&&being&

the&least&important&reason:

1)&I&love&working&with&kids

2)&I&love&teaching

3)&I&want&to&be&able&to&get&to&know&a&dierent&culture

4)&I&want&to&connect&with&my&italian&roots.

5)&Its&an&aordable&way&of&travelling&and&gemng&to&know&dierent&places&and&people.


Fax: +390293580439 Tel: +393497946488


!!!!I"Soa"Berrotaran"conrm"that"all"the"informa2on"supplied"on"this"form"is"true"and"correct."!!!

Date&8th&May&2015&& & &Signature&!

Special&wishes&and/or& important& remarks& for&your&placement:& I&would& love&to&be&placed& in&a& family& that& is& interested& in&music&

since& is& something& that& Im&very&passionate&about&and& I&enjoy& teaching& it& very&much.&Preferably& in&a&big&city& such&as&Rome&or&

Florence.&!


Fax: +390293580439 Tel: +393497946488


!AU PAIR REFERENCE -childcare

!Please&indicate&your&opinion&about&the&level&of&the&applicants&abili]es&in&each&of&the&following&categories.&Please&rate&the&applicants&quali]es&in&the&following&areas:&1=&low;&2&=fair;&3=good;&4=&excellent;&5=&superior&!___&Love&for&children&___&Maturity&___&Independence&___&Pa]ence&___&Punctuality&___&Ability&to&handle&emergencies&___&Ability&to&carry&out&instruc]ons&___&Honesty&___&Enthusiasm/Humor&!Do&you&recommend&the&applicant&to&be&placed&as&an&au&pair?&!&!I&hereby&conrm&that&all&the&informa]on&above&is&correct.&!!Name / Surname: Signature Date: !. .. / / . !

Applicants&name: !! Your&name:Your&address: Your&Phone&

number:&

How&long&have&you&known&the&applicant?&

What&is&Your&rela]onship&to&the&applicant?&

How&long&the&applicant&helped&you&with&your&children?&

Did&the&applicant&drive&your&children&somewhere?

How&many&]mes&per&week&did&the&applicant&take&care&of&your&children?&

How&many&children&did&the&applicant&look&aher&?&

How&old&were&they?&

Did&the&applicant&help&with&housework?

YES&&&&&&&&&NO

Please&describe&the&applicants&du]es?

!


Fax: +390293580439 Tel: +393497946488


!! !2 AU PAIR REFERENCE- character

!Please&indicate&your&opinion&about&the&level&of&the&applicants&abili]es&in&each&of&the&following&categories.&Please&put&a&]ck&V&in&the&relevant&level&boxes&below&which&you&think&is&acceptable.&

Applicants&name: !! Your&name:Your&address: Your&Phone&

number:&

How&long&have&you&known&the&applicant?&

How&do&you&know&the&applicant&(employer,&neighbor,&teacher)?&

What&is&Your&rela]onship&to&the&applicant?&

How&long&the&applicant&helped&you&with&your&children?&

How&would&you&describe&the&applicants&personality&and&character?

Please&give&your&opinion&of&the&applicants&ability&to&handle&new&situa]ons&and&possible&stress,&culture&shock:

SKILLS Excellent Good Fair Poor Not

Applicable

Responsibility

Friendliness

Honesty

Maturity

Ability&to&discipline&children

Flexibility

Helpfulness

Punctuality

Cleaning

Tidying

Ironing

Basic&cooking


Fax: +390293580439 Tel: +393497946488


!!!Do&you&recommend&the&applicant&to&be&placed&as&an&au&pair?&&!I&hereby&conrm&that&all&the&informa]on&above&is&correct.&!!Name / Surname: Signature Date: . .. / / . !


Fax: +390293580439 Tel: +393497946488


! !AU PAIR MEDICAL CERTIFICATE

Applicants medical information

!PHYSICIANS/INFORMATION/

!HAS/THE/APPLICANT/EVER/HAD/(OR/CURRENTLY/HAS):/

Full&Name: Date&of&Birth:

Gender Male&&&&&&&&&&&&Female Blood&Type:

Name&of&the&Doctor&and/or&Clinic:&

Telephone:

Address:&

Asthma Yes&& No&&&&& Dizziness Yes&& No&&&&&

Anorexia Yes&& No&&&&& Headaches Yes&& No&&&&&

Chicken&Pox Yes&& No&&&&& Allergies Yes&& No&&&&&

Heart&Disease Yes&& No&&&&& Emo]onal&Disorders Yes&& No&&&&&

Measles Yes&& No&&&&& Tuberculosis Yes&& No&&&&&

Epilepsy Yes&& No&&&&& Anaemia Yes&& No&&&&&

Hepa]]s Yes&& No&&&&& Arthri]s Yes&& No&&&&&

Seizures Yes&& No&&&&& Bulimia Yes&& No&&&&&

Diabetes Yes&& No&&&&& Depression Yes&& No&&&&&

Mumps Yes&& No&&&&& German&Measles Yes&& No&&&&&

Malaria Yes&& No&&&&& Other Yes&& No&&&&&

If&the&answer&is&Yes&to&any&of&the&above&ques]ons,&please&give&details&and&dates.

Has&the&applicant&undergone&surgery&of&any&kind?&

If&yes,&please&give&details.&

Do&you&recommend&the&applicant&to&be&placed&as&an&au&pair&to&look&aher&children?&

Has&the&applicant&ever&received&treatment&for&psychological&problems?&

If&yes,&please&give&detail:&


Fax: +390293580439 Tel: +393497946488


!!I&cer]fy&that&the&above&informa]on&is&complete&and&accurate&and&all&important&medical&informa]on&has&been&included.&!Doctors Stamp: Doctors Signature Date: !

!

Is&the&applicant&restricted&physically&and/or&mentally?&

If&yes,&please&give&detail:&


Fax: +390293580439 Tel: +393497946488


!AU/PAIR/AGREEMENT&&

I(fullname)______________________________________________________________&1. conrm& that& I& have& read& all&wrieen&materials& provided& by& the& au& pair& agency& in&my& home&

Country& and& my& host& Country& and& that& I& fulll& all& criteria.& I& understand& that& the& au& pair&program&is&a&cultural&exchange&program&and&not&a&contract&of&work.&I&am&aware&that&being&an&au&pair&requires&a&high&degree&of&both&responsibility&and&exibility&and&that& I&must&take&my&du]es&seriously.&

2.& I& conrm& that& I& have& answered& all& ques]ons& honestly& and& that& all& informa]on& in& the&applica]on&is&true.&

3.& Aher&conrma]on&of&placement,& I& shall& stay& in& touch&with&my&host& family&and&shall& inform&them&of&my&travel&arrangements.&I&agree&not&to&travel&to&my&host&family&un]l&I&have&received&an&ocial&conrma]on&of&placement&from&the&au&pair&agency.&

4.& I& shall& be& familiar& myself& with& all& (if& any)& visa& requirements.& I& shall& obtain& necessary&documents& (e.g.,& a& valid& passport)& prior& to& departure& and& shall& not& enter&my&host& country&without&a&proper&visa&(if&required).&

5.& I&agree&to&cover&all&costs&for& language&courses,&travel&to&and&from&my&host&country&and&any&debts& incurred& (e.g.,& telephone& bills,& etc.).& I& shall& bring& emergency& funds& with& me& (as&recommended&by&the&au&pair&agency)&to&pay&for&unforeseen&expenses.&

6.& I&am&familiar&with&and&agree&to&abide&by&all&program&guidelines&and&condi]ons,&in&par]cular&those& regarding:& the& number& and& distribu]on& of& working& hours,& au& pair& du]es,& pocket&money,& free& ]me,& holidays,& language& courses,& transporta]on& costs,& insurance& and& the&termina]on&of&an&au&pair&arrangement.&

7.& Upon& arrival& in&my& host& country,& I& shall& discuss& in& detail& with&my& host& family& the& daily& or&weekly&rou]ne&and&my&and&their&expecta]ons&of&the&au&pair&programme.&

8.& I&shall&carry&out&my&child&care&and&light&housekeeping&du]es&with&diligence.&In&addi]on&to&my&au&pair&du]es,&I&agree&to&keep&my&room&clean&and&neat&and&to&make&a&fair&contribu]on&to&the&cleanliness&of&the&"common&areas"&of&my&host&family's&home.&

9.& I&agree&to&abide&by&all&house&rules&set&by&the&host&family&(e.g.,&use&of&telephone&and&facili]es&within& the& home,& day]me& and& overnight& visitors,& curfew,& smoking,& etc.).& During&my& stay& I&shall& behave& in& a&manner&which& does& not& reect& badly& upon&my&host& family,& both& au& pair&agencies&or&my&home&country.&

10.& & I&shall&seek&the&advice&of&the&host& family&before&administering&any&form&of&discipline&on&the&children.&Under&no&circumstances&shall&I&hit&the&children&or&leave&them&alone.&

11.&&&&I&shall&discuss&with&my&host&family&any&arrangements&for&holidays&well&in&advance.&&12.& I&shall&make&a&concerted&eort&to&experience&the&culture&of&my&host&country&and&to&learn&the&

language.&I&shall&respect&cultural&dierences&and&display&tolerance&towards&others.&13.& I&realize&that&the&success&of&my&au&pair&stay&depends&largely&on&my&own&ini]a]ve.&I&shall&try&to&

integrate&myself& into& family& life&and,& should&any&problems&arise,& communicate&openly&with&the&family&and&ac]vely&seek&a&solu]on.&

14.& If& I&have&any&problems&or&ques]ons&which&cannot&be&discussed&and&resolved&with& the&host&family,&I&shall&contact&the&au&pair&agency&in&my&host&country&for&assistance.&&

15.& I&shall&make&every&eort&to&resolve&any&dierences&with&my&host&family.&If&no&solu]on&can&be&reached&and&I&decide&to&leave&the&family,&I&agree&to&give&advanced&no]ce&of&minimal&2&weeks.&


Fax: +390293580439 Tel: +393497946488


!During& this& ]me& period,& I& shall& perform& my& normal& du]es& and& receive& room,& board& and&pocket&money.&If&I&request&to&be&placed&with&a&new&family,&I&realise&this&might&involve&moving&to&a&dierent&city.&!

16.& I&understand&that&I&shall&be&expelled&from&the&program&and&must&return&home&if:&!& G&I&fail&to&abide&by&this&agreement&or&program&guidelines.&

G& I& falsify&any& informa]on& in&my&applica]on&(e.g.,& regarding&smoking,&child&care&experience,&health,&etc.).&

G& I&begin&my&au&pair&stay&before&receiving&an&ocial&conrma]on&of&placement&from&the&au&pair&agency&or&a&proper&visa,&if&required.&

& G&I&am&responsible&for&repeated&problems&with&several&families.&& G&I&disobey&the&laws&of&my&host&country.&!17.& I&agree& to& leave&my&host&country&before&my&visa&or& residency&permit&expires& (if&applicable)&

and&I&will&no]fy&the&police&and&the&au&pair&agency&of&my&departure.&!18.& I&shall&not&undertake&any&other&paid&employment&and&will&perform&only&those&tasks&related&to&

the&au&pair&program.&!19.& Should&I&decide&to&cancel&my&applica]on,&I&shall&inform&the&au&pair&agency&at&once.&!20.& I& shall& no]fy& the& au& pair& agency& immediately& if& there& are& any& changes& to& the& informa]on&

included&in&my&applica]on.&!!!Date&____________________&&&&&&&&&&Signature&________________________________________&

! !


Fax: +390293580439 Tel: +393497946488


international au pair italy

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