Application Form Kina – Anixi Au Pair

Application Form Kina

Hej! Kul att du vill bli au pair. Vi ser fram emot att hjälpa dig komma iväg på ett oförglömligt äventyr. Då sätter vi igång!

Personal Information - Step 1 of 8

Name *

Email *

E-post

Bekräfta e-post

Date of birth:

Nationality:

Gender

Passport Details

Passport no.:

Passport issued in:

Passport date of issue:

Expiration date:

Skype:

The best time to contact you:

Phone

Address:

Postal Code:

City:

Country:

Native Language:

Chinese level:

None
Beginner
Intermediate
Fluent
Native speaker

Language Knowledge

English

Excellent
Good
Fair
Poor
None

French

Excellent
Good
Fair
Poor
None

Spanish

Excellent
Good
Fair
Poor
None

German

Excellent
Good
Fair
Poor
None

Other:

Religion:

Do you attend church/temple?

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Planned Program Duration:

90 days
180 days

Will you consider an extension?

If yes, how long for?

90 days extension
180 days extension

Earliest arrival date:

Latest arrival date:

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Do you have any pre-existing medical or disabilities?

If yes, please explain:

Do you have any allergies?

If yes, please explain:

Do you have any physical or medical restrictions?

If yes, please explain:

Do you take medications or drugs regularly?

If yes, please explain:

Have you been vaccinated against covid-19?

Have you ever needed treatment, counseling or hospitalization for a psychological or psychiatric condition?

If yes, please explain:

Are you currently recovering from an injury or chronic diseases (HIV positive, Hepatitis etc.)?

If yes, please explain:

Have you ever suffered from or sought treatment for depression, alcoholism, drug addiction, or an eating disorder?

If yes, please explain:

Please describe yourself:

Non-‐Smoker
Smoker
Occasional/social smoker

If social smoker, how often?

If you smoke, can you agree not to smoke in your Host Family’s home and whenever responsible for or with the children?

Have you ever been convicted of a felony or misdemeanor not including traffic violations?

If yes, please explain:

Do you have any dietary restrictions?

If yes, please explain:

Have you ever been away from home for longer than 2 months?

If yes, please indicate when, where, why and for how long?

Are you planning a holiday/vacation before you leave?

If yes, please indicate when and where we can reach you while you are away:

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Father's Name:

Father's Occupation:

Father's Email:

Father's Phone:

Mother's Name:

Mother's Occupation:

Mother's Email:

Mother's Phone:

If you have any siblings, list their names and ages below:

Who do you presently live with?

Please describe type of housework you do at your home (cooking, cleaning, etc.):

Have you experienced any major life changes in the past year? If yes, please explain.

Have you ever lived away from home? If yes, please explain.

Have you ever been to China? Have any of your family members been to China?

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Have you obtained your country’s secondary/high school diploma?

Have you completed or are you currently enrolled in post-secondary studies?

If no, do you intend to further your education?

Please specify your educational information.

Are you currently or have you ever been employed?

If yes, please specify your employment experience besides work caring for children.

Have you received any additional non-degree education courses or job training?

If yes, please describe:

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Hobbies/Interests

Swimming
Tennis
Soccer
Basketball
Volleyball
Table tennis
Golf
Biking
Skiing
Gymnastics
Badminton
Artwork
Singing
Dancing
Reading
Writing
Cooking
Computer
Arts and crafts
Violin
Guitar
Piano/keyboard
Photography
Voluntary work

Describe your hobbies/interests a bit further or list any other hobbies not listed above:

Certificated Skills

TEFL
First Aid
Childcare/Babysitting
Coaching (e.g. sports)
Life Saving Certificate
CPR
Other

Do you mind living with a Host Family that followed a special diet (e.g. vegetarian, kosher, etc.)?

Do you mind living with pets?

If yes, please list what pets you cannot live with and the reason:

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Have you ever tutored English as a second language?

If yes, please specify your tutoring objects (pupils) and general methods:

Please describe how you plan to assist your Host Family with child education, especially foreign language tutoring:

What activities (both outdoors and indoors) would you like to do with the children in your Host Family?

Why should a family choose you as their Au Pair?

Experience with children ages:

Newborn – 1 year
1 - 3 years
3 - 6 years
6 -9 years
9+ years
Children with disabilities

Willing to care for children ages:

Newborn – 1 year
1 - 3 years
3 - 6 years
6 -9 years
9+ years
Children with disabilities

Number of children (the more flexible you are the more options you will have):

I’m flexible
1 – 2 children
1 – 3 children
3 – 4 children
4+ children

Please describe all the ways in which you have gained your child care experience:

Au pair
Summer activity camp
Babysitting, full time
School teacher
Tutoring children
Day care center for children
Caring for younger family members
Youth or church group/club
Nanny
Babysitting, evening
Babysitting, daytime
Support school teacher
Coaching children’s sports
Teaching after school activities
Music teacher
Other*

*Please describe:

I have experience in these areas caring for children 0 – 2 years of age:

Preparing baby formula (milk)
Feeding a baby with a spoon/fork
Putting a baby to bed
Preparing baby food
Changing a diaper
Feeding a baby with a bottle
Bathing a baby
Burping a baby
Dealing with tantrums
Caring for a colicky baby

I have experience in these areas caring for children older than 2 years of age:

Giving baths and/or putting to bed
Teaching or tutoring
Doing arts and crafts projects
Playing outdoors
Dealing with tantrums
Assisting with homework
Involving kids in play and activities
Playing indoors
Potty training
Other*

*Please describe:

Describe talents/skills you have that are useful when caring for children:

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Do you want to be in contact with other au pairs and do you agree that your email is given to other au pair participants?

Genom att kryssa i rutan och skicka in min ansökan intygar jag att jag har läst, godkänt och samtycker till Anixi:s allmänna villkor och integritetspolicy.

Name *

Först

Sist

Date: *

Name

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Hej! För att spara din ansökan klicka continue nedan och på nästa sida fyller du i din epost. En länk där du kan återuppta din ansökan kommer sedan att skickas till din epost.

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Din ansökan har sparats och en unik länk har skapats där du kan öppna upp din ansökan igen och fortsätta på den.

Skriv in din epost nedan för att få länken skickad till dig eller så kan du kopiera och spara länken själv.

OBS! Din ansökan kommer att sparas i 30 dagar om den inte är klar inom den perioden kommer den att raderas.

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