form site janka

Fields Marked with a * are required
*Full Name (Firstname Surname]:
*First Name:
*Surname:
*Age:
*Sex:
Family:
Family:
Height (cm):
Weight (kg):
*Date Of Birth:	None
*Nationality (country):
Religion:
Practising:
I Live In (home Location) :
Type Of Location:
Telephone No:
Mobile No:
Fax No:
*Email:
Address:
Address(during College):
Contact Preference:
Contact (2nd Choice):
Photograph 1:
Photograph 2:
Photograph 3:
Photograph 4:
Photograph 5:
*You Are...:
Highest Qualification:
If Working Give Details Below:
If Studying Give Details Below:
Fathers Job:
Fathers Age:
Mothers Job:
Mothers Age:
Age Of Brother 1:
Age Of Brother 2:
Age Of Brother 3:
Age Of Brother 4:
Age Of Sister 1:
Age Of Sister 2:
Age Of Sister 3:
Age Of Sister 4:
Number Of Years Of English Study:
*How Would You Rate Your English Skills:
I Plan To Attend Language Classes In The Uk (study:
I Wish To Take Qualitications In English In The Uk:
German Language:
French Language:
Spanish Language:
Italian Language:
Hungarian Language:
Russian Language:
Polish Language:
Czech Language:
Slovak Language:
Romanian Language:
*Have You Passed A Driving Test?:
Date Of Issue:	None
International Driving Licence?:
Licence Of European Union?:
*How Often Do You Drive?:
*Earliest Start Date:	None
Latest Start Date:	None
*Preferred Period Of Stay - In Months:
Can This Be Extended?:
By How Many Months?:
Are You Able To Stay In Uk Over?:	Christmas Easter Summer Holiday
City (what Location do You Prefer?):
Town (what Location do You Prefer?):
Village (what Location do You Prefer?):
Rural/farm (what Location do You Prefer?):
Preferred Locations:	city town village rural/farm
Neutral Locations:	city town village rural/farm
Unwanted Locations:	city town village rural/farm
Mother/father+children (type Of Family You Prefer):
Mother+children (type Of Family You Prefer):
Father+children (type Of Family You Prefer):
Mother/father Only (type Of Family You Prefer):
With Live-in Elderly Relative (type Of Family You:
Both Parents Working (family Work Arragements You:
Mother At Home (family Work Arragements You Prefer:
Father At Home (family Work Arragements You Prefer:
Father Away Overnight (family Work Arragements You:
Mother Away Overnight (family Work Arragements You:
Ages Of Children Preferred:	0-2 2-5 6-10 10+ Don't mind
Care For Babies (type Of Role You Prepared To Do):
Care For Children (type Of Role You Prepared To Do:
Care For Older Children (type Of Role You Prepared:
Care For Disabled Children (type Of Role You Prepa:
Care For Elderly (type Of Role You Prepared To Do):
What Work Are You Prepared To Do In A Family:	Light Housework Washing Ironing Shopping (Food/Grocery) Cooking for Children Gardening Handiwork Driving Caring for Pets Cooking for Family
Do You Have Any Experience With Children?:	Babysitting Worked with Children's clubs Previous Au Pair Experience Experience Caring for Babies Experience Caring for 2-5 old Children Experience Caring for 6-10 old Children Experience Caring for 10+ old Children Worked in kidergarten Worked at a summer camp Worked at a school Voluntary work with Children
Professional Childcare Qualification (if Yes, Spec:
Please Give Details Of Childcare Experience (as Mu:
Playing Sport (rate The Following Hobbies..):
Watching Sport (rate The Following Hobbies..):
Craftwork (rate The Following Hobbies..):
Watching Tv (rate The Following Hobbies..):
Photography (rate The Following Hobbies..):
Socialising With Friends (rate The Following Hobbi:
Reading (rate The Following Hobbies..):
Listening To Music (rate The Following Hobbies..):
Dancing (rate The Following Hobbies..):
Drawing/painting (rate The Following Hobbies..):
Pets/animals (rate The Following Hobbies..):
Playing Musical Instrument (rate The Following Hob:
Cooking (rate The Following Hobbies..):
Walking/hiking (rate The Following Hobbies..):
Computer/email/web (rate The Following Hobbies..):
Theatre (rate The Following Hobbies..):
Cinema (rate The Following Hobbies..):
Do You Play Any Musical Instrument?:
If Yes, Please Specify (piano, Violin, Guitar, Etc:
What Sports Do You Like To Play?:	Aerobics Badminton Basketball Cycling Football Gym (Weights/circuit training) Gymnastics Hill Walking Hockey Horse Riding Ice Skating Mountaineering Roller Blading Roller Skating Running Squash Swimming Table Tennis Tennis Volleyball
Can You Swim?:
Do You Have First Aid Training Or Experience?:
What Do You Think About Your Personality?:	Quiet Sociable Funny Neat and tidy Active Organiser Helpful Co-operative Talkative Like my own company Caring Independent Uses initiative Motivated Sensitive Warm hearted Friendly Strict Responsible Flexible Positive Attitude Polite Disciplined Hard Working
If you had to choose. (1)...:
If you had to choose (2)....:
If you had to choose (3)....:
If you had to choose (4)....:
How Long Have You Been Away From Home Before (in M:
Does Your Family Support You In This Application?:
List Any Previous Full-time Jobs:
Do You Smoke?:
If Yes, Are You Prepared Not To Smoke In Family Ho:
Do You Like To Socialise?:
Do You Exercise?:
Any Special Diet Requirements (vegetarian,vegan)?:
If Vegetarian Are You Prepared To Handle Meat And:
If Family Vegetarian - Will You Follow A Vegetaria:
Asthma (do You Suffer From Any Diseases?):
Diabetes (do You Suffer From Any Diseases?):
Other (do You Suffer From Any Diseases?):
If Other, Please specify:
Dairy (do You Have Any Allergies?):
Gluten (do You Have Any Allergies?):
Nuts (do You Have Any Allergies?):
Dust (do You Have Any Allergies?):
Pets (do You Have Any Allergies?):
Other (do You Have Any Allergies?):
If Other, Please Specify:
Please Write Any Other Details About Yourself And:
Have You Ever Had A Criminal Conviction?:
If Yes, Please Give More Details::
Contact Name, Address And Telephone Number in Case:
Date: