Countrywide Aupair2ireland Questionnaire – Jane Kidd
AU PAIR PROFILE 
Tel/Fax:  02844 615106
AUPAIRS FOR FAMILIES LIVING IN EVERY PART OF IRELAND

Your full Name:
Full postal Address:						

Telephone number:			
Mobile telephone number:		
E-mail address:	

Age:
Sex:				
Date of Birth: 			
Nationality:	
Married/Single:	
Religion:
Would you prefer a family of the same religion:		 					
Height: 	
Weight:  		
Passport / Identity card number:

Do you have a full drivers license:  
If yes, is this for an automatic car only:
Would you be prepared to drive as part of your au pair duties:
Have you ever had car insurance in your own name at home:

Parents/guardians contact number/address (in case of emergency)
Names:			
Address: 				
Telephone: 			
Father’s profession: 		
Mother’s profession: 
Brothers & Sisters/Ages:	

What are you doing at the moment: – 

When can you  start: 

When do you want to return home(Approximately):  

English Language Skills:
How good are your English language Skills:
(Not good) 1 – 2 – 3 – 4 – 5  (reasonable) – 6 – 7 – 8 - 9 - 10(very good)
Do you think you could speak to your host family by telephone:

Could you speak using email to your host family:

Can you cook:       		
Not at all:
A little:                 
Yes, well:

Are you a vegetarian/Vegan:  
If yes, would you be prepared to cook meals with meat
for the children of the family if so required:

Do you smoke: 
If yes, Are you willing not to smoke during working hours:

Health and Security questions:
As you may be living in the family home of your host family, we need to know the answers to the following questions:

Have you ever been an au pair before and if yes, please give details: 

Have you ever worked abroad before, if yes please give details: 

Have you ever been in trouble with the police, if yes please give details: 
Have you ever had a problem with illegal drugs:  
Have you ever had a problem with alcohol:  

Have you ever had a mental health problem that the family should know about: 

Do you have any allergies what so ever: 

Do you take medication for your continued good health, which the family should know about for your own safety (epilepsy/Depression etc): 

Do you have any chronic ailment which the family should know about (Bad back etc?):  

(answering Yes to any of the above does not stop you for getting a job through this agency but we must have an answer to these questions..)

CHILD CARE EXPERIENCE:
Have you taken a first aid course:

Have you taken care of children in the following circumstances:
During the day on your own:	 
Fed them without help:			
Put them to bed without help: 		
Baby-sit at night alone: 			
Baby-sit overnight alone:		
Changed a nappy/Diaper:		
Given a child/baby a bath:			

What age children are you happiest with(yes/prefer not):  
Age of Children		   Yes 		           Maybe		         Prefer Not
Infants up to 12 months	
Toddlers up to 24 months  
Children 2-5 years: 			
Children 5-10 years			
Children over 10 year:	

Would you be prepared to accept a child with special needs: 
(Down syndrome, Autism, hyperactivity,):  

Child Care
Do you have experience with children, if yes, explain:

Do you think you have the skills and patience to 
Keeping children occupied during the day: 
play with them:
Help them with Drawing, Painting: 
Could you  bring them swimming, to football, walking etc: 

Would you be prepared to accept a single parent family:  
Mother only:      
Father only: 	

As part of an au pair duties you will be expected to do some light housework, are you agreed to this (this does not mean all of the housework, just some of it) 
These duties could include: (please answer yes/no)

Tidying children’s play area:   	 
Tidy  children’s bedroom and bathroom: 	
helping to prepare and tidy up after meals:  
Filling and emptying dishwasher:  
The use of a vacuum cleaner and duster may be required for the above: 

LAUNDRY:
You may be required to do some laundry for yourself and sometimes for the children, this usually means putting the clothes into the washing machine and taking them out again and putting them on the clothes line or in the dryer:
Do you think you could do this: 

Have you ever done laundry before:
Do you know how to operate a washing machine:	
A drying machine:  
If no, are you prepared to learn: 

IRONING:
Would you be prepared to do Ironing:
Children Only:
Whole family:
Prefer not to do ironing:

YOU AS A PERSON, YOUR LIKES AND DISLIKES
What are your  special interests, 
Are you interested in a particular sport / hobby: 

Can you swim:  
Ride a bike:   
Play tennis:     
Horseback ride:  

Do you like animals:     
If asked, would you be happy to feed/exercise the pets in the host family: 

Are you interested in music:  

Do you play a musical instrument:  

Are you interested in dancing, singing, art etc:  

Location of Host Family
Where would you like your host family to live: 
(Please indicate your choice 1,2,3,4,5)
In a large city:  
In a large town:  
In a smaller town: 
In the country :
In a rural area, perhaps on a farm: 
We cannot always guarantee that we can give you a suitable family in the area of your choice, but we will do our best.

References.
You will need to supply some  written reference if you are a short term applicant or 2 references if you are coming for more than 3 months.  You can fill in the information here or supply written references on separate pages:
Name of 1st Referee: 
Postal Address:
Telephone number:
Email address:
When did you work for this person/people/How do you know this person:
What were your duties: 

Name of 2nd Referee:  
Postal address:
Telephone number:  
Email address:
When did you work for this person/people:
What were your duties:

 Dear Family Letter
In your own words, write a  "DEAR FAMILY OR EMPLOYER" letter explaining who you are, what you have done and what you hope to do with your life and giving some details of the kind of person you are.  You may come to live with these people for 6 months plus and the better the letter, the more opportunities will be open to you. 

Dear Family,

DECLARATION….I declare that the information supplied by me in this document is a true and accurate description of myself and my family and my experience to date and that I fully understand the term `Au Pair` and the duties I will be required to perform and that I am willing and able to undertake such duties for the duration of my stay in Ireland outlined in conditions supplied to me by the host family of my choice.

I agree to give 7 days notice of my intention to leave either to the agency or directly to the family should I wish to go home early or change family or take other employment for any reason. 

 Printed Name: 
Date:  
CHECK LIST

Make sure you have fill in all the questions.

Please also supply:

•	Passport size photo and other photos if they are available.
•	Written references from previous employers or teacher
•	Medical certificate if you are coming for more than 3 months
•	Police certificate if you are coming for more than 6 months
•	Copy of drivers license  if you are going to drive as part of your duties

Make sure that your passport is up to date.

If you have recently been a student, please bring your student card as you can get discount on rail and buses in Ireland as a student.

Please register for a European Union Health Insurance Card which is available to all members of the E.U. – you can ask at your Doctors Surgery where to get such a card.
This is important as it covers you for any medical expenses which might arise out of an accident or illness while you are abroad………...

Travel Insurance. It is always advisable to get travel insurance which will cover your baggage and belongings some medical expenses – talk to your travel agency.

Private Medical Insurance – if you have private medical insurance, please tell your insurance company that you are going abroad and you can perhaps have it transferred to cover you while you are away from home. 

Purchase an Electrical adaptor as the Electricity current in the British Isles/Ireland  is 240 and not the same as mainland Europe and you will need a travel adaptor for all your electrical goods – hairdryer etc. you can buy at any airport.

Mobile phones ..It is advisable that you purchase an Irish Sim card so that you have an Irish Mobile phone number which will be much cheaper for you to make local calls while you are here as well as calls to home.  A sim card costs Euro 20 from Irish mobile telephone companies beginning with  085, 086, 087 which ever you prefer. Some families provide mobile phones for their aupairs. You can purchase a SIM card at most irish airports upon arrival.

Also see HOPEFULLY HELPFUL HINTS FOR AUPAIRS available from this office.

Jane Kidd and Staff……aupairs4ireland@ireland.com
Tel:  0044 2844 615106