Name Address Telephone
Date of Birth Age Nationality Religion
Height Weight
Knowledge of English: Beginner Elementary Lower intermediate Intermediate Upper intermediate Advanced Teacher of english
Father's profession Mother's profession Number of sisters Age Number of brothers Age
Household tasks and duties which you are used to doing: Washing Ironing Cooking General cleaning Baby-sitting
Do you smoke? No Yes How many cigarettes a day? Can you restrict your smoking to outside the house and not smoke when with the children? No Yes If you say you do not smoke and they find you smoking in the house, they may ask to leave No Yes
Do you have a driving licence? No Yes How long have you held it? Are you willing to drive if asked to? No Yes
Do you like animals? No Yes Are you a vegetarian? No Yes
Do you like babies? No Yes Are you happy to work with all ages of children? No Yes Have you had any other practice in the care of children?
What hobbies and leisure activities do you enjoy?
Do you want to take language lessons? No Yes Do you speak any other languages?
Name and full address of your parents
I have read the information supplied and understand the requirements of the position I am applying for. I also understand that I have to pay for my own fare as that the Host Family is not responsible for this.
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