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First Name

Middle Name

Last Name

Username

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Terms and Conditions

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Name of father

Age of father

Occupation father

Name of mother

Age mother

Occupation mother

Secondary address

Address family

Region/County

Tax Code

VAT number

Telephone

Telephone of father

Telephone of mother

Fax

Mobile

Religion

Name and age of children

Children’s school timetable

Languages father

Languages mother

Languages children

Domestic animals

Type of help required

Au-Pair / Ragazzi alla pari

Nanny / Bambinaia

English tutor / Tutore di inglese

Mothers help / Aiuto alla madre

Babysitter not resident / Babysitter non residente

Date when work is to commence

Date when work is to finish

Job description

Number of hours worked per day

live in

live out

morning

afternoon

Free day(s) per week

Weekly wages

Are you willing to pay the air-fare home after the girls one year stay ?

Yes

Preferences regarding the following?

Is it necessary to know English ?

Yes

Is it necessary to know Italian?

Yes

Type of accommodation provided

Own bedroom / Stanza personale

Own bathroom / Bagno personale

WIFI available / Wifi disponibile

Use of TV / Televisione

Use of telephone / Telefono

Use of mobile phone / Uso del cellulare

Any other domestic staff

Other information (family, holidays, town...)

Address

Telephone parents

Occupation Father/Mother

Brother(s), sister(s) ages

Place of birth

Date of birth

Nationality

Height

Weight

Passport n°

Valid until

Education info

Certificates

Present Occupation

Early start date

Latest start date

Future plans

How long would you like to stay?

Which of the following do you prefer?

City

Countryside

Little Town

Suburbs

Preferred area

Preferred country

Would you drive for the family?

Yes

Do you smoke?

Yes

yes, but I will not smoke in the house / Sì, ma non fumerò in casa

Do you possess a valid driving licence?

Yes

Programme name

Au Pair / Ragazzi alla pari

Nanny / Bambinaia

English tutor / Tutore di inglese

Mothers Help / Aiuto alla madre

Babysitter not resident / Babysitter non residente

Have you had any health problems in the past?

Do you suffer from any Allergies?

Do you have a special Diet?

Have you ever lived away From home?

Yes

English

None / Nessuna

Poor / Scarsa

Sufficient / Sufficiente

Good / Buona

Others language

Italian

None / Nessuna

Poor / Scarsa

Sufficient / Sufficiente

Good / Buona

Spanish

None / Nessuna

Poor / Scarsa

Sufficient / Sufficiente

Good / Buona

German

None / Nessuna

Poor / Scarsa

Sufficient / Sufficiente

Good / Buona

French

None / Nessuna

Poor / Scarsa

Sufficient / Sufficiente

Good / Buona

Would you like to attend a language course?

Yes

Describe below all your childcare experience in as much detail as possible. List: ages of children, responsibility etc.

Have you taken any course relating to Childcare?

Have you any professional qualifications?

Do you have any other talent/skills which may be useful i.e. first aid?

What experience do you have in domestic work?

Please describe your hobbies, interests and sports:

Do you know how to swim?

Yes

Do you have experience with disabled children?

Yes

Are you willing to care for a disabled child?

Yes

Preferences about the age of children

Are you willing to work with a single mother/father?

Yes

If not please explain

How many children do you wish to care for?

Would you be willing to work additional hours for more pay?

Yes

Have you ever been arrested/in trouble with the law?

Yes

Skype

Monday

Tuesday

Wensday

Thursday

Friday

Saturday

Sunday

Any other info?

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