SECTION 1. PERSONAL DETAILS
I NSTRUCTIONS:
Fill in the application form
on-line. Please answer all questions giving as much detail as
possible about yourself. All fields marked with a
*
are required and must be completed
Send us
either by e-mail , fax or
post the following:
Minimum 2 references,
preferably to do with child care. Otherwise character or employment
references are acceptable. No references from relatives please.
Minimum 1 photo
A note from your doctor
confirming you are in good health
A copy of your Id. Acceptable forms of Id are: passport, identity
card, driving licence
A letter written to
your prospective family, any relevant certificates or diplomas
(1st aid, life-saving, child care, nanny or teaching diploma)
and photographs of you with children, a
police check , a
live presentation are much
appreciated.
These documents are not essential but make your application much
more attractive.
Once your
application has been received you will be given a reference N °
that you will need to quote on all correspondence, e-mails or when
contacting us by telephone
First
Name*
Last Name *
Home Tel N°: (country
code first)
-
Work Tel N°: (country
code first)
-
Mobile Tel N°:
(country
code first)
-
Preferred
Tel N°:
(country
code first)
-
Fax N°:
(country
code first)
-
E-mail: *
Skype:
Address Line 1: *
Address Line 2:
City: *
County/State: *
Zip/Postal Code: *
Country: *
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Antilles (NL)
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermudas
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
British Indian Ocean
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Cezch Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Denmark
Djibouti
Domenican Republic
Dominica
Easter Islands
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hawaiian Islands
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Islands
North Korea
North Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcaim
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome/Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
St. Helena Island
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincente and the Grenadines
South Africa
South Korea
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor Lorosae
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
Unt. Emir. Arab
United Kingdom
Unlisted
Uruguay
USA
U.S. Virgin Islands
Uzbekistan
Vanuatu
Vatican State
Venezuela
Vietnam
Wake Islands
Wallis and Futuna
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Next of kin
(if different from above) Address Line 1: *
Next of kin
Address Line 2:
Next of kin
City: *
Next of kin
County/State: *
Next of kin
Zip/Postal Code: *
Next of kin
Country: *
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Antilles (NL)
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermudas
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
British Indian Ocean
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Cezch Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Denmark
Djibouti
Domenican Republic
Dominica
Easter Islands
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hawaiian Islands
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Islands
North Korea
North Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcaim
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome/Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
St. Helena Island
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincente and the Grenadines
South Africa
South Korea
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor Lorosae
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
Unt. Emir. Arab
United Kingdom
Unlisted
Uruguay
USA
U.S. Virgin Islands
Uzbekistan
Vanuatu
Vatican State
Venezuela
Vietnam
Wake Islands
Wallis and Futuna
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Next of Kin
Tel N°:
(country
code first) *
-
Nationality: *
Please note that if your nationality is
not listed unfortunately at the present time we cannot accept
you on our program
Nationality
Andorra
Argentina
Australia
Austria
Belgium
Bolivia
Brazil
Brunei
Canada
Cezch Rupublic
Chile
Colombia
Costa Rica
Croatia
Cyprus
Denmark
Dominician Republic
Ecuador
El Salvador
Estonia
Finland
France
Germany
Greece
Guatemala
Holland
Honduras
Hungary
Iceland
Ireland
Israel
Italy
Japan
Latvia
Liechtenstein
Lithuania
Luxembourg
Malasyia
Malta
Mexico
Monaco
New Zealand
Nicaragua
Norway
Panama
Paraguay
Poland
Portugal
Romania
San Marino
Singapore
Slovak Republic
South Africa
South Korea
Spain
Sweden
Switzerland
United Kingdom
United States of America
Uruguay
Vatican State
Venezuela
Zimbabwe
If you have dual nationality
please specify your other nationality
Dual Nationality
Andorra
Argentina
Australia
Austria
Belgium
Bolivia
Brazil
Brunei
Canada
Cezch Rupublic
Chile
Colombia
Costa Rica
Croatia
Cyprus
Denmark
Dominician Republic
Ecuador
El Salvador
Estonia
Finland
France
Germany
Greece
Guatemala
Holland
Honduras
Hungary
Iceland
Ireland
Israel
Italy
Japan
Latvia
Liechtenstein
Lithuania
Luxembourg
Malasyia
Malta
Mexico
Monaco
New Zealand
Nicaragua
Norway
Panama
Paraguay
Poland
Portugal
Romania
San Marino
Singapore
Slovak Republic
South Africa
South Korea
Spain
Sweden
Switzerland
United Kingdom
United States of America
Uruguay
Vatican State
Venezuela
Zimbabwe
Religion:
Marital St atus: *
Marital Status
Single
Living with Partner
Married
Gender: *
Gender
Female
Male
Age: *
D.o.B. :*
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Jan
Feb
Mar
Apr
May
Jun
July
Aug
Sept
Oct
Nov
Dec
Present Employment: *
(please state position & how long you have been employed there)
Past Employment: *
(please state positions & length of employment)
Education: *
Qualifications: *
Are you a Qualified
Teacher, Nurse or Nanny?
--
Yes
No
Have you done
a:: *
Child Care
Course
Life-Saving
Course
1st
Aid Course
What is your
mother tongue? *
--
Afrikaans
Albanian
Arab
Armenian
Azerbaijani
Belorusan
Bengali
Bosnian
Bulgarian
Burmese
Cezch
Croatian
Danish
Dzongkha
English
Estonian
Faroese
Farsi
Finnish
Flemmish
French
Georgian
German
Greek
Greenlandic
Hebrew
Hindi
Hungarian
Icelandic
Indonesian
Irish
Italian
Japanese
Kazakh
Khmer
Kirghiz
Korean
Lao
Latvian
Lithuanian
Macedonian
Malay
Maldivian
Mandarin Cinese
Marshallese
Mongolian
Nepali
Norwegian
Panjabi
Polish
Portuguese
Romanian
Russian
Serbian
Sinkala
Slovak
Slovenian
Spanish
Swahili
Swedish
Tajiki
Tamil
Thai
Turkish
Turkmenistan
Tuvalvan
Ukranian
Urdu
Uzbek
Vietnamese
What is your
level of spoken English? *
--
Mother Tounge
Excellent
Good
Average
Basic
Do you speak
any foreign languages?
To make multiple selections hold down the ctrl key
Afrikaans
Albanian
Arab
Armenian
Azerbaijani
Belorusan
Bengali
Bosnian
Bulgarian
Burmese
Cezch
Croatian
Danish
Dzongkha
English
Estonian
Faroese
Farsi
Finnish
Flemmish
French
Georgian
German
Greek
Greenlandic
Hebrew
Hindi
Hungarian
Icelandic
Indonesian
Irish
Italian
Japanese
Kazakh
Khmer
Kirghiz
Korean
Lao
Latvian
Lithuanian
Macedonian
Malay
Maldivian
Mandarin Cinese
Marshallese
Mongolian
Nepali
Norwegian
Panjabi
Polish
Portuguese
Romanian
Russian
Serbian
Sinkala
Slovak
Slovenian
Spanish
Swahili
Swedish
Tajiki
Tamil
Thai
Turkish
Turkmenistan
Tuvalvan
Ukranian
Urdu
Uzbek
Vietnamese
Experience with children: (please go into detail stating dates,
country, length of employment, ages of children & if it was
live-in)
Interests & hobbies (including sports): *
Do you: *
Drive?
Swim?
Cook? Smoke?
Have you lived
away from home? *
--
No
Yes
Are you
prepared to do housework for the family? *
--
No
Yes
Ages of
brothers & sisters?
Do you have any allergies/illnesses or disabilities and have you
ever or do you suffer from depression? *
(if yes please go into details)
Are you taking or
have you ever taken any medication for mental illness? *
--
No
Yes
Have you ever taken
illegal substances? *
--
No
Yes
Do you have a
criminal record? *
--
No
Yes
Father's
Profession: *
Mother's
Profession: *
Which is the
earliest date you could leave? *
--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--
Jan
Feb
Mar
Apr
May
Jun
July
Aug
Sept
Oct
Nov
Dec
--
2012
2013
If there is particular time off
you will need (e.g. because you need to attend a wedding etc)
during your stay please specify these here:
Length of
stay: *
(please note that stays of less than 6 mths are only available
for maternity nurse positions or for summer positions
-June-September-)
--
1 month
2 months
3 months
4 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months
18 months
2 years
2 years or more
Do you have to
give notice to your present employer? *
--
Yes
No
If yes please
state the length here:
SECTION 2. PREFERENCES
What type of
position were you looking for? *
--
Any
Au-Pair
Maternity Nurse
Mother's Help
Nanny
Ages of
children you would prefer to look after? *
Do you like
animals? *
--
No
Yes
Would you
prefer to be placed in the: *
--
City
Countryside
Either
Would you
prefer a mother that: *
--
Either
Is at home
Works
Which
country/countries would you like to go to? *
(to make multiple selections press the ctrl key)
To make multiple selections hold down the ctrl key
Any
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Antilles (NL)
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermudas
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
British Indian Ocean
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Cezch Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Denmark
Djibouti
Domenican Republic
Dominica
Easter Islands
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hawaiian Islands
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Islands
North Korea
North Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcaim
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome/Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
St. Helena Island
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincente and the Grenadines
South Africa
South Korea
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor Lorosae
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
Unt. Emir. Arab
United Kingdom
Unlisted
Uruguay
USA
U.S. Virgin Islands
Uzbekistan
Vanuatu
Vatican State
Venezuela
Vietnam
Wake Islands
Wallis and Futuna
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
What minimum
weekly pay were you expecting? *
--
US Dollar
Afghanistan Afghani
Albanian Lek
Algerian Dinar
Andorran Franc
Andorran Peseta
Angolan New Kwanza
Argentine Peso
Aruban Florin
Australian Dollar
Bahamanian Dollar
Bahraini Dinar
Bangladeshi Taka
Barbados Dollar
Belize Dollar
Bermudian Dollar
Bhutan Ngultrum
Bolivian Boliviano
Botswana Pula
Brazilian Real
British Pound
Brunei Dollar
Bulgarian Lev
Burundi Franc
CFA Franc BCEAO
CFA Franc BEAC
Cambodian Riel
Canadian Dollar
Cape Verde Escudo
Cayman Islands Dollar
Central Pacific Franc
Chilean Peso
Chinese Yuan Renminbi
Colombian Peso
Comoros Franc
Costa Rican Colon
Croatian Kuna
Cuban Peso
Cyprus Pound
Czech Koruna
Danish Krone
Djibouti Franc
Dominican R. Peso
ECU
East Caribbean Dollar
Ecuador Sucre
Egyptian Pound
El Salvador Colon
Estonian Kroon
Ethiopian Birr
Euro
Falkland Islands Pound
Fiji Dollar
Gambian Dalasi
Ghanaian Cedi
Gibraltar Pound
Gold (oz.)
Guatemalan Quetzal
Guinea Franc
Guyanese Dollar
Haitian Gourde
Honduran Lempira
Hong Kong Dollar
Hungarian Forint
Iceland Krona
Indian Rupee
Indonesian Rupiah
Iranian Rial
Iraqi Dinar
Israeli New Shekel
Jamaican Dollar
Japanese Yen
Jordanian Dinar
Kazakhstan Tenge
Kenyan Shilling
Kuwaiti Dinar
Lao Kip
Latvian Lats
Lebanese Pound
Lesotho Loti
Liberian Dollar
Libyan Dinar
Lithuanian Litas
Macau Pataca
Malagasy Franc
Malawi Kwacha
Malaysian Ringgit
Maldive Rufiyaa
Maltese Lira
Mauritanian Ouguiya
Mauritius Rupee
Mexican Peso
Mongolian Tugrik
Moroccan Dirham
Mozambique Metical
Myanmar Kyat
NL Antillian Guilder
Namibia Dollar
Nepalese Rupee
New Zealand Dollar
Nicaraguan Cordoba Oro
Nigerian Naira
North Korean Won
Norwegian Kroner
Omani Rial
Pakistan Rupee
Palladium (oz.)
Panamanian Balboa
Papua New Guinea Kina
Paraguay Guarani
Peruvian Nuevo Sol
Philippine Peso
Platinum (oz.)
Polish Zloty
Qatari Rial
Romanian Leu
Russian Rouble
Samoan Tala
Sao Tome/Principe Dobra
Saudi Riyal
Seychelles Rupee
Sierra Leone Leone
Silver (oz.)
Singapore Dollar
Slovak Koruna
Slovenian Tolar
Solomon Islands Dollar
Somali Shilling
South African Rand
South-Korean Won
Sri Lanka Rupee
St. Helena Pound
Sudanese Dinar
Sudanese Pound
Suriname Guilder
Swaziland Lilangeni
Swedish Krona
Swiss Franc
Syrian Pound
Taiwan Dollar
Tanzanian Shilling
Thai Baht
Tonga Pa'anga
Trinidad/Tobago Dollar
Tunisian Dinar
Turkish Lira
Uganda Shilling
Ukraine Hryvnia
Uruguayan Peso
Utd. Arab Emir. Dirham
Vanuatu Vatu
Venezuelan Bolivar
Vietnamese Dong
Yugoslav Dinar
Zambian Kwacha
Zimbabwe Dollar
How did you find our web site ? *
--
None
Club Teli
E-mail
Foreignplanet.com
Greataupairjobs.net
Goabroad.com
Google
Jobs Abroad
KiwiAupair Agency
Lycos
MsnSearch
NannyJobUK
Other
Other Search Engine
Trade-exchange.co.nz
Word of mouth
Yahoo
If you stated other
above please specify (quote correspondent or agency name if
applicable)
Any other relevant information which
you feel is important:
If you have browsed our
summary of available positions and have seen one or more
families you are interested in quote their Ref N° here:
If you have been registered before with
our agency please quote your ref N° here. If this is the case
you do not need to send your documents again
If you would like to be contact
directly by host families please tick the box
By
clicking submit I
declare that I have read all the information on working in a family
abroad and the content of the the Totalnannies website and I accept
the conditions. I also declare to accept the below terms and
conditions and that all the information on this application form is
true..