Application Form | Fiche d’inscription PARIS REGIONS
SOUTH OF FRANCE
SUMMER AU PAIR
Surname of applicant: Nom de famille de la candidate: First name of applicant: Prénom de la candidate: 2-3 months 2-3 mois
Length of stay desired: Durée de votre sejour:
6-8 months 6-8 mois
9-12 months 9-12 mois
Earliest date I could depart: A quelle date pourriez-vous partir le plus tôt:
(MM/DD/YYYY)
Latest date I could depart: A quelle date pourriez-vous partir le plus tard:
(MM/DD/YYYY)
Latest date I have to return to my home country: A quelle date devriez vous rentrer au plus tard:
(MM/DD/YYYY)
Which area do you prefer (not possible for summer stays)? Quelles sont vos régions préférées (pas de choix pour l’été)?
City Ville
Small town Petite ville
Country Campagne
Address: Adresse: Town: Ville:
State:
Postal Code: Code postal:
Home Telephone: Telephone privé:
Mobile: Portable:
Fax: Numéro fax:
Email: Email:
Country: Pays:
Date and place of birth: Date et lieu de naissance: Height: Taille:
Age: Age:
Weight: Poids:
Nationality: Nationalité:
Father’s occupation: Profession du père:
Religion: Religion:
Marital Status: Situation de famille:
Passport No: No. de passeport:
Valid Until: Valable jusqu’au:
Mother’s occupation: Profession de la mère:
Current occupation: Actuellement employé comme:
Age of brothers and sisters: Age des frères et soeurs: Education: Formation scolaire: Profession: Profession: Do you smoke? Fumez-vous?
Yes Oui
No Non
How many cigarettes each day? Combien de cigarettes par jour?
Would you be willing to quit before the program begins? Pourriez-vous cesser de fumer avant le début de votre programme?
WA-HG12-0715
Yes Oui
No Non
Page 1 of3
WORKING ABROAD Au Pair in France
Do you have a driving licence? Avez-vous un permis de conduire?
Yes Oui
Since when? Depuis quand?
Automatic transmission
Driving experience: Expérience de conduite:
Good Bonne
Do you regularly attend religious services? Etes-vous pratiquante?
Yes Oui
No Non
Are you a vegetarian? Etes-vous végétarienne?
Yes Oui
No Non
Do you like animals? Aimez-vous les animaux?
Yes Oui
No Non
Do you have knowledge of first aid? Expérience des premiers soins?
Yes Oui
No Non
Can you swim? Savez-vous nager?
Yes Oui
No Non
No Non
Sufficient Suffisante
Manual transmission
Poor Peu fondée
None Aucune
Would you look after animals? Pourriez-vous vous occuper des animaux?
Yes Oui
No Non
Can you horse ride? Savez-vous monter à cheval?
Yes Oui
No Non
If not, why? Si non, pourquoi?
What are your hobbies? Quels sont vos passe-temps? Can you play any sports or musical instruments (please describe)? Est-ce que vous faites du sport / jouez d’un instrument de musique? E xpliquez
Do you suffer from allergies? Souffrez-vous d‘allergies? Other diseases? D’autres maladies: Knowledge of languages: Connaissance des langues:
Excellent Excellente
Good Bonne
Sufficient Poor Suffisante Peu fondée
French / Français
English / Anglais
Other languages / D’autres langues
Would you like to attend a language course? (not possible for summer stays) Désirez-vous suivre un cours de langue?
Yes Oui
Years Années
No Non
Are you experienced in child care of children in the following ages: Votre expérience de garde d’enfants:
Baby Nouveau né
9-12 months 9-12 mois
1-3 years 1-3 ans
3-6 years 3-6 ans
Are you happy to care for any age? Acceptez-vous de vous occuper d’enfants de tous les ages?
Yes Oui
6-10 years 6-10 ans No Non
If not, which age range do you prefer? Si non, quels âges préfériez-vous? How often did you look after them (frequency)? Combien de temps les avez-vous gardés?
WA-HG12-0715
Page 2 of3
WORKING ABROAD Au Pair in France
Have you taken any courses relating to childcare? Avez-vous participé à un cours concemant la garde d‘enfants?
Yes Oui
No Non
Do you have experience with disabled children? Avez-vous de l‘expérience avec des enfants handicapés?
Yes Oui
No Non
Are you willing to care for a disabled child? Etes-vous d‘accord de vous occuper d‘un enfant handicapé?
Yes Oui
No Non
What is the maximum number of children you would feel comfortable caring for at a time? Combien d’enfants maximum pourriez-vous garder? Are you willing to work with a single mother or single father? Etes-vous d‘accord de travailler avec une mère seule, un père seul?
Yes Oui
No Non
Would you be willing to work additional hours for more pay? Etes-vous disposée à travailler plus d‘heures pour plus d‘argent?
Yes Oui
No Non
children enfants
What experience do you have in domestic work (specify)? Quelles activités ménagères vous sont familières (précisez)? Have you ever been an au pair before? If so, in which country and for how long (please provide us with references!)? Avez-vous déjà vécu une expérience Au Pair? Dans quel pays et pour combien de temps (merci de joindre une référence!)? No Non
Yes Oui
I confirm that I have committed no criminal offenses and that I will provide a copy of my criminal history report to InterExchange with my application. J’atteste que je n’ai commis aucun délit ni aucune infraction et que je transmets à InterExchange une copie de mon casier judiciaire avec mon dossier d’inscription No Non
APPLICATION FOR ADMISSION ... to apply for transfer of credit, please submit your course outline, course structure and grading system to our office together.
BIRTH CERTIFICATE: Original and photocopy of ACTE DE NAISSANCE (Copie Integrale). If born in the Philippines, Authenticated Birth Certificate in Security ...
of stay. (months). N° of expected. ECTS credits. Preferred Professor at Host. Institution for main subject. (if applicable). DD/MM/YYYY ............................ DD/MM/ ...
Each issue focuses on a specific as- pect of islands development and cultural life. The membership fees are: ⢠70 euros for individual. ⢠190 euros for institution.
Position within the company: Senior Manager for Failure Analysis. Preferred EUFANET Board of Directors Position: Secretary. Candidate short resume: â¢. Ph.D in ...
Transport and accomodation must be paid by the. Organisers. Do You invite official Technical Delegate? Do You invite official ITTC-classifiers? Do You invite ...
2) Personal statement of one page at least, outlining the personal, academic, or professional rea- sons for choosing aPss at eGe Rabat, as an intensive arabic ...
within the last six (6) months, without eyeglasses, clearly showing the full front view of the face of the applicant. Please paste. Before accomplishing this Form, ...
Recognition panels 'approved list' you will need to apply on the basis of having ... contacted by email or telephone, we will still need a postal address as we will.
DISCLAIMER : I accept that participation in any activity organised by the BCWA is entirely at my own risk and responsibility. ln no way do I hold the BCWA liable ...
31 mars 2017 - concrete projects in order to ensure sustainable and inclusive growth for Africa and France: this is the ambition of the third programme, Young ...
lived for a period of two years or more in your acquired gender. There is ... These guidance notes should answer most of the questions you may have regarding ...
Feb 21, 2008 - Department of Homeland Security - Form I-901 Application - Receipt... https://www.fmjfee.com/i901fee/students/creditcardsuccess.htm. 1 sur 1.
Please read all of the application instructions before completing this form. ... supplied by me on this application is true and correct to the best of my knowledge.
t Check payable to « ITO - colloque» t Bank transfer IBAN FR76 3000 3035 0100 0501 2961 754. BIC. SOGEFRPP. Please return this form with your payment to:.
Introduction. â« Formal ..... Early Carnap used the theory of types syntactically for the 'logical construction of the ... Strawson 'On referring' (1950): âThe actual.
I wish to receive Pachacamac's Newsletter/gazette by email (In this case, the mention of your email in the form above is mandatory). The address to send the ...
