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Nedsa Au Pair – Netherlands and SA _ Nederland en SA

Please fill out this form DIGITALLY (on the computer).Please answer the following information form as honest and complete as you can.

Please upload the form to your profile or send to: [email protected] vorm DIGITAAL in (op die rekenaar)Antwoord asb die volgende inligting so eerlik en volledig as

moontlik en laai dit dan op jou profiel of stuur na: [email protected]

GENERAL INFORMATION/ALGEMENE INLIGTING

Full namesVolle voornameSurname/ VanAge OuderdomNationalityNasionaliteitDate of birthGeboortedatum

Place of birthGeboorteplekHome address, zip code, city, countryHuisadres, kode, dorp/stad en landEmail-address E-PosadresPhone numberTelefoonnommerSkype name and FB-name Skypenaam en FB-naamCurrent occupation (work, study, just passed schoolHuidige beroep( werk, studie,

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Head and shoulderphoto of applicant

Kop en skouersfoto van aansoeker

mailto:[email protected]

mailto:[email protected]


net skool verlaat)Have you been an au pair before? (when/ where?)Was jy al voorheen n au pair?(wanneer/waar?)Highest level of education completed (secondary school/matric/university)Hoogste vlak van opleiding klaargemaak( sekondêre skool/matriek/universiteit

General physical information/ Algemene fisiese inligting.

Length (in centimetres)Lengte (in sentimeter)Weight (in kilograms)Gewig ( in kilogram)Are you mentally in a good state of health and have you always been so in the past?(if not, please explain)Is jy geestelik in ’n goeie gesondheidstoestand en was jy altyd so in die verlede?

Yes /No, specify Ja/Nee, spesifiseer

Are you physically healthy and have you always been in the past? Is jy fisies gesond en was jy ook so in die verlede?

Yes /No, specify Ja / Nee, spesifiseer

Are there any (mental or physical) health problems in

Yes / No, specify Ja / Nee, spesifiseer

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your family?Is daar enige (geestelike en fisiese) gesondheidsprobleme in jou familie?Do you have allergies? Het jy enige allergieë?

Yes /No, specify Ja / Nee, spesifiseer

Special diet(If so, please explain)

Volg jy enige dieet? (indien wel, verduidelik)

I do not follow any diet / Vegetarian / Vegan / Other diet, specify:I like/don't like;I am / am not willing to cook meat & fish for the family, please specify:Ek volg geen dieet/Vegetaries/ Vegan/ Enige ander dieet, spesifiseerEk hou / hou nie van:Ek is gewillig/ nie gewillig om vis en vleis voorteberei( te kook)vir die familie, spesifiseer

Do you smoke?Rook jy?

Yes / NoJa /Nee

Do you take medicine or have you taken medicine in the past?Gebruik jy medikasie of het jy medikasie in die verlede gebruik?

Yes, Specify: /No

Ja, spesifiseer: / Nee

Do you have a tattoo? (yes, specify)Het jy n tattoo?(ja , spesifiseer)

Yes /no

Ja/Nee

Do you have any piercings? (if so, please specify)Het jy enige gaatjies?(piercings)(ja, spesifiseer)

Yes/no

Ja/Nee

Qualifications /Kwalifikasies

English level (spoken)Engelse vlak (praat)

1 Bad / 2 Below average / 3 Average / 4 Good / 5 Advanced 1.Swak/2 Ondergemiddeld/ 3 Gemiddeld./ 4 Goed /5 Gevorderd

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Other languages Ander tale

- ……1 Bad / 2 Below average / 3 Average / 4 Good / 5 Advanced 1.Swak.2 Ondergemiddeld/ 3 Gemiddeld/ 4 Goed/5 Gevorderd

Biking experience Fietsry-ervaring

1 Bad / 2 Below average / 3 Average / 4 Good / 5 Advanced 1 Swak/2 Ondergemiddeld/3 Gemiddeld/ 4 Goed/5 Gevorderd

Drivers license Bestuurslisensie

Yes/no Since: __________ For what___________Ja/nee Sedert __________ Kode:

Cooking level Kookvlak

1 Bad / 2 Below average / 3 Average / 4 Good / 5 Advanced1.Swak/2 Ondergemiddeld/3 Gemiddeld/4 Goed/5 Gevorderd

Do you like cooking?Hou jy van kook?

a bit / 2 it’s ok / 3 a lot / 4 I love it1 ‘n Bietjie/2 Dis ok/ 3 Baie/ 4 Mal daaroor

First aid

Noodhulp

Yes / No / No, but I’m willing to take a first aid training when I’m in the NetherlandsJa/Nee/ Nee, maar ek is gewillig om n kursus te doen in Ndl

Can you swim? Kan jy swem?

Yes / No / Specify level:Ja /Nee / Spesifiseer vlak

Which school and university did you attend? (detail)Watter skool en universiteit het jy bygewoon? (detail)

Do you have a school diploma? Which subjects?Het jy n matrieksertifikaat?Meld jou vakke

Yes / No

Ja / Nee

What was your major and date of Graduation?Wat was jou hoofvakke en datum van graduering (univ)

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Explain your previous job experiences ( including child care, volunteering):/ Verduidelik jou vorige werkservaring (insluitende kinderoppas, vrywillig)

Job: Werk Duration Hoe lank Tasks & ResponsibilitiesTake en Verantwoordelikhede

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Experience with children / Ervaring met kinders

Period of time Tydperk

FrequencyFrekwensie

Activities / duties / responsibilitiesAktiwiteite/pligte en verantwoordelikhede

Age(s) of child(ren)

Ouderdom van kind(ers)

Relation to child(ren)Verhouding met die kind(ers)

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How much experience do you have with babies? * (0-2 years old)?

Hoeveel ervaring het jy met babas?

(0 – 2 jr oud)

□ Feeding babies /Voeding van baba Yes/No Ja/Nee□ Bathing babies/Bad van baba Yes/ No Ja/Nee□ Playing with children/ Speel met kinders Yes/ No Ja/Nee□ Going out on the street with children Yes/No Gaan straat toe met die kinders Ja/Nee□ Bringing and picking up from kindergarten Yes/ No Bring en gaan haal kinders by kleuterskool Ja/Nee□ Teaching children/ educational games Yes/No

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Leer die kinders/opvoedkundige speletjies Ja/Nee□ Doing outside activities with children Yes/ No Doen buite-aktiwiteite met kinders Ja/Nee□ Putting in to bed for nap Yes/ No Sit die kinders in die bed vir n middagslapie Ja / Nee□ Giving lunch/dinner / Gee middag en aandete Yes/No Ja/Nee □ Dressing babies/ Klee van babas Yes/ No Ja/Nee□ Bringing to bed at night? /Neem bed toe saans Yes/ No Ja/NeeSpecify any of the above/ Spesifiseer enige van bg.

How much experience do you have with toddlers? (2 – 4 years old) Hoeveel ervaring het jy met kleuters?(2-4 jariges)

□ Playing with children/Speel met kinders Yes/ No Ja /Nee□ Going on the street with children

Yes/ No Gaan straat toe met die kinders Ja/Nee□ Bringing and picking up kids from kindergarten

Yes/ No Bring en gaan haal kinders by kleuterskool Ja/Nee□ Teaching children/ educational games Yes/ No Leer kinders/opvoedkundige speletjies Ja / Nee□ Doing outside activities with children Yes/ No Doen buite-aktiwiteite met die kinders Ja /Nee□ Giving lunch/dinner to Children Yes/ No Gee die kinders middag-/aandete Ja / Nee□ Dressing children/ Klee die kinders Yes/ No Ja / Nee□ Bringing children to bed Yes/ No Bring die kinders bed toe saans Ja/NeeSpecify:Spesifiseer:

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How much experience do you have with older kids? (4 years and older)

Hoeveel ervaring het jy met ouer kinders?( 4 jaar en ouer)

□ Playing with children/ Speel met kinders Yes/ No Ja/Nee□ Going on the street with children

Yes/ No Gaan straat toe met die kinders Ja /Nee□ Bringing and picking up kids from school Yes/ No Bring en gaan haal die kinders by die skool Ja / Nee□ Teaching children/ educational games Yes/ No Leer kinders/ opvoedkundige speletjies Ja/Nee□ Doing outside activities with children Yes/ No Doen buite-aktiwiteite met die kinders Ja /Nee□ Giving lunch/dinner to Children Yes/ No Gee middag/aandete vir die kinders Ja /Nee□ Dressing children/ Klee die kinders Yes/ No Ja/Nee□ Helping children with homework Yes/ No Help die kinders met huiswerk Ja / nee□ Bringing children to bed Yes/ No Neem die mkinders bed toe saans Ja/NeeSpecify:Spesifiseer:

How many kids did you watch/ take care of at the same time?

Na hoeveel kinders het jy al gelyktydig omgesien?

□ 1 □ 2 □ 3 □ 4 or more Specify:

□ 1 □ 2 □ 3 □ 4 of meerSpesifiseer:

Do you have experience with disabled children?Het jy ervaring met gestremde kinders?

Yes / No

Ja /Nee

Are there things you are not willing to do? (related to children)

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Is daar bepaalde dinge wat jy NIE bereid is om te doen nie ( verwant aan kinders)What do you like the most about children? Waarvan hou jy die meeste wat kinders betref?

What do you find a challenging aspect of working with children? Wat is vir jou die uitdagendste aspek om met kinders te werk?

What are your favourite activities with children?

Wat is jou gunsteling aktiwiteite met kinders?

0-2:

2-4:

4-8:

8-12:

What would you do if a child gets ill?Wat gaan jy doen as n kind siek word?

How would you discipline the children?Hoe gaan jy die kinders dissiplineer?

Household experience /Huishoudelike ervaring(Please note that all the light household tasks mentioned below are normal duties of the au pair and can be asked by your future host family)Neem kennis dat al die ligte huishoudelike take normale pligte van n au pair is en mag dus deur die gasgesin gevra word)

Do you have experience with these household tasks? (can be experience in your own home)

□ Making lunch/dinner for children Yes/ No Maak middag en aandete vir kinders Ja / Nee□ Cooking lunch/dinner for adults Yes/ No Kook middag-/aandete vir volwassenes

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Het jy ervaring van die volgende take?(kan dit ook in jou eie huis doen)

Ja / Nee□ Doing dishes/packing/unpacking dishwasherYes/ No Was skottelgoed/in en uitpak van skottelgoed masjien Ja/ Nee□ Doing groceries / Koop kruideniersware Yes/ No Ja/Nee□ Vacuum cleaning/ Stofsuig Yes/ No Ja/ Nee□ Washing clothes/ Wasgoed was Yes/ No Ja/Nee□ Folding clothes/ Vou van klere Yes/ No Ja/ Nee□ Ironing clothes/ Stryk van wasgoed Yes/ No Ja /Nee□ Changing beds (sheets)/Skoon lakens oortrek Yes/Nee Ja/Nee □ Clearing up /Opruim

Yes/ No Ja/Nee□ Other: / Ander:

Do you (used to) have personnel in your own house?

Het julle iemand in julle huis wat die huis skoonmaak? Of het gehad?

□ No □ Nee□ Personnel who cleans the house Personeel wat die huis skoonmaak.□ Personnel who cooks Personeel wat kook□ Personnel who irons Personeel wat stryk□ Personnel who changes beds sheets Personeel wat die skoon lakens oortrek□ Other personnel (garden etc): … Ander personeel (tuin etc):Specify how much time:Spesifiseer hoeveel tyd:

How would you describe your housekeeping style?Hoe sal jy julle huishoudstyl beskryf?Extra information / comments:Ekstra informasie/Kommentaar

Preferences /Voorkeure

When are you

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available to start?Wanneer is jy beskikbaar om te begin ?Maximum period of stay (preferably + max 1 year)Maksimum tydperk van verblyf (verkieslik 1 jaar)Where are you willing to live?Waar is jy bereid om te bly?

Anywhere/ Big city/Small city/ Country sideEnige plek/ Groot stad/ klein stad/ platteland

Will take care of children in the age of:Wil graag na kinders kyk in die ouderdom van:

Babies (0 - 2 years old) / Babas (0-2jaar)Toddlers (2 – 4 years old) / Kleuters (2-4 jaar)Older (4 and up) / Ouer (4 jaar en ouer)All ages / Alle ouderdomme

Maximum amount of children Maksimum aantal kinders

2,3,4 or more/ of meer

What gender of kids do you relate more to?Met watter geslag kom jy die beste oor die weg?

Boys/ Girls/I have no preferences

Seuns/ Dogters/ Geen voorkeur nie

Are there things you ‘d rather not do (Related to household) and why?Is daar bepaalde huishoudelike take wat jy liewer nie wil verrig nie en hoekom?

Prefer to do a Dutch course ?Verkies jy om n Ndl taalkursus te doen? ?

Yes/NoJa/Nee

Are you willing to take care of a child with disabilities? Is jy bereid om na n

Yes/No

Ja/ Nee

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kind te kyk met gestremdhede?Are you willing to stay with a single parent family? Is jy bereid om by n enkelouer te bly?

Yes/No

Ja/Nee

Are you willing to care for pets?e.g walk the dog if asked?Is jy bereid om na troeteldiere te kyk?( bv. met die hond te gaan stap?

Yes/No

Ja/Nee

Are you willing to stay / cooperate with a stay at home mom or dad? Is jy bereid om te bly by n gesin met ’n ouer wat van die huis af werk of by die huis is?

Yes/No

Ja/Nee

Reference (exclusively about your experience with children) this person may be contacted for information and reference form):/ Referente waar jy ervaring opgedoen het.Hierdie persoon mag ook gekontak word deur die agent.

o Name of referenceNaam van referent

o Address/ Adres

o Email-address E-pos adres

o Phone numberTel nommer

Reference (about your experience with children or about your character); (this person may be contacted for information): / Referent wat gekontak word oor jou ervaring met kinders en ook oor jou karakter

o Name of refereeNaam van referent

o Relationship to candidate au pair

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o In watter hoedanigheid

o Character reference

Beskryf karakter van au pair

o Address/ Adres

o Email-address E-pos adres

o Phone numberTel nommer

Personal life / lifestyle/ Persoonlike lewenstyl

Describe how you grew up/ Beskryf hoe jy opgegroei hetLIVING AREAWOON AREA

TYPE OF HOMETIPE HUIS

PETSTROETELDIERE

Large city/Groot stad

Villa /Groot huis No/Nee

Small city/Klein stad

Townhouse/Tuinhuis

Yes/Ja

Town/village/Dorp Apartment/flat/ Woonstel

Specify/spesifiseer

Country sidePlatteland

Farm / country housePlaas

SIBLINGS/BROERS EN SUSTERS PARENTS/OUERS

No/NeeMother/Moeder

Yes/Ja - Name(s)/Name

- Age(s)/Ouderdomme

- Occupations(s)/Beroep

- name/naam - occupation/beroepFather/Vader: - name/naam - occupation/beroep

Describe your relationship with your sibling(s):Beskryf jou verhouding met jou broers/susters

Describe your relationship with your parents:Beskryf jou verhouding met jou ouers

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How where you raised by your family?Hoe is jy grootgemaak deur jou ouers?

Did you ever live away from home?(if so, please specify/If not why do you want to do this now)Het jy ooit weg van die huis gebly?( beskryf hoekom jy dit nou wil doen?Have you ever lived in another country?Het jy ooit in n ander land gewoon?Do you need to help out with the household? (if so, please specify)Moes jy ooit help met die huishouding (spesifiseer)What does a typical day look like for you? (waking up time / activities / bedtime / eating habits) Hoe lyk n tipiese dag vir jou?(Opstaantyd, aktiwiteite, slaaptyd, eetgewoontes?Are you religious? (if so, please specify)

And do you go to church, or other / how often?) Is jy godsdienstig? En gaan jy nog kerk toe?Are you open minded towards other

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people’s religious beliefs?Is jy verdraagsaam teenoor ander menses se religieuse oortuigings?Interests / hobbiesBelangstellings /HobbiesDo you have any special talents?Het jy enige spesiale talente?Which sports do you do and how often/ which sports do you like?Watter sport doen jy en hoe dikwels beoefen jy dit?

Contact 1 in case of emergency / Kontak 1 in ‘n noodgevalo Relation to the au pair o Verhouding met au pairo Full name/ Volle name o Address/Adreso Phone/ Telefoonnommero Cell phone/Selnommero Skype name/Skype

adres/naam o Email address /E-

posadres

Contact 2 in case of emergency :/Kontak 2 in n noodgevalo Relation to the au pair o Verhouding met au pairo Full name/ Volle name o Address/ Adreso Phone/ Telefoonnommero Cell phone/Selnommero Skype name /Skype

adres/naamo Email address / E-

Posadres

Characteristics and personality/ Karaktertrekke en persoonlikheid

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How would you describe your personality?Hoe sal jy jou persoonlikheid beskryf?How would a close family member describe your personality?Hoe sal n gesinslid jou persoonlikheid beskryf?How would you characterize your strengths?(name 3 or more) Please give examples of situationsHoe sal jy jou sterkpunte karakteriseer? 3 of meer en gee asb voorbeelde.How would you characterize your weaknesses?(name 3 or more) Please give examples of situationsHoe sal jy jou swakpunte karakteriseer? 3 of meer en gee asb voorbeelde.Which traits do you possess? 1 Not at all 2 no 3 normal 4 yes 5 very much

Oor watter van die volgende trekke beskik jy? 1. Glad nie2. Nee

□ Social/ Sosiaal 1 – 2 – 3 – 4 - 5 □ Cheerful/ Vrolik 1 – 2 – 3 – 4 - 5□ Enthusiastic /Entoesiasties 1 – 2 – 3 – 4 - 5□ Extravert /Ekstravert 1 – 2 – 3 – 4 – 5□ Introvert/Introvert 1 – 2 – 3 – 4 – 5□ Proactive/Pro-aktief 1 – 2 – 3 – 4 - 5□ Energetic/Energiek 1 – 2 – 3 – 4 - 5□ Caring/Omgee 1 – 2 – 3 – 4 - 5□ Flexible /adaptive/ Aanpasbaar 1 – 2 – 3 – 4 - 5 □ Active / Aktief 1 – 2 – 3 – 4 - 5□ Organised/georganiseerd 1 – 2 – 3 – 4 - 5□ Responsible /Verantwoordelik 1 – 2 – 3 – 4 - 5□ Smart/ Slim 1 – 2 – 3 – 4 -

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3. Normaal4. Ja5. Baie

5□ Self-reliant/ self onderhoudend 1 – 2 – 3 – 4 - 5□ Emotional/Emosioneel 1 – 2 – 3 – 4 - 5□ Modest/Beskeie 1 – 2 – 3 – 4 - 5□ Polite/Beleefd 1 – 2 – 3 – 4 - 5□ Honest / open/Openlik/eerlik 1 – 2 – 3 – 4 - 5 □ Quiet/Stil/rustig 1 – 2 – 3 – 4 - 5□ Creative/Kreatief 1 – 2 – 3 – 4 - 5 □ Patient/Geduldig 1 – 2 – 3 – 4 - 5□ Reliable/Betroubaar 1 – 2 – 3 – 4 – 5□ Open minded/Oopkop 1 – 2 – 3 – 4 – 5

Do you suffer from home-sickness?Ly jy aan “home sickness”?What kind of people do you find it most difficult to work with? Why? How do you try to work with them?Met watter tipe mense kom jy moeilik oor die weg? Hoekom? Hoe gaan jy probeer om met hulle saam te werk?When something is bothering you, what do you do? How do you receive criticism and how do you resolve conflicts? (give an example)Wat doen jy as iets jou pla? Hoe neem jy kritiek op en hoe los jy probleme op? Gee n voorbeeld.

Motivation and Expectations/ Motivering en Verwagtings

What is your motivation for becoming an au pair (again)?Wat is die rede dat jy n au pair wil word?

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Why do you want to leave what you are doing now?Hoekom wil jy los waarmee jy nou besig is om te gaan au pair?Why do you want to go to the Netherlands?Hoekom wil jy spesifiek Nederland toe gaan?Do you know anyone in the NL?(Specify relationship, name, address)Ken jy iemand in Ndl? ( spesifiseer die verhouding, naam en adres asb)What key aspects are you looking for in your experience abroad as an au pair?Wat is die sleutelaspekte waarna jy kyk as jy wil gaan au pair?What do you think is expected of you as an au pair? Both characteristics and specific tasksWat dink jy word van jou verwag as n au pair – karaktergewys en spesifieke take.

What do you expect of your host family?Wat verwag jy van die gasgesin?Do you have any special wishes?Het jy enige spesiale wense?What do you think could be the hardest/

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most difficult part of your au pair program?Wat dink jy kan die moeilikste deel van die au pairprogram wees?Can you describe what you feel to be an ideal au pair living environment?Beskryf asb hoe jy die ideale leefomgewing sou sien?How would you spend your free time in the Netherlands?Wat gaan jy in jou vrye tyd in Nederland doen?Do you have any personal issues now or issues that have happened in your past that would be good for us, and your future host-family, to know? Is daar enige huidige “issues” of “issues” in die verlede waarvan die gasgesin en agentskap moet weet?What are your long-term interests and goals after your au pair experience?Wat is jou lang termyn belangstellings en doelwitte nadat jy au pair het?Why should a host family choose you?(Choose 3)Hoekom moet n gasgesin jou kies?

Because I am: Omdat ek-Caring/Omgee ; proactive/pro -aktief; sportive/sportief trustworthy/betroubaar; Creative/kreatief; outgoing/uitgaande; helpful/behulpsaam; self

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(Kies 3) reliant/selfonderhoudend; Modest/beskeie; Adaptable/aanpasbaar; Open minded/oopkop; -Very experienced with children/baie ervare met kinders is-Very experienced with household chores/baie ervare met huishoudelike take is.

Extra questions needed for the process/ Ekstra vrae wat nodig is vir die proses

Do you have any other reason for travelling to the Netherlands, besides your participation in the au pair program? Het jy enige ander redes, behalwe die van die au pairprogram, hoekom jy na Nederland wil gaan?What information do you know about the Netherlands in terms of geography, language and culture?Wat weet jy reeds van Nederland wat betref die geografie, taal en kultuur?Have you ever been in the Netherlands before? If yes, please mention the dates and purpose of your visitWas jy al van te vore in Nederland? Indien wel verskaf asb die datums en die doel van die besoek.Did you ever apply for a visa with the aim of travelling to the Netherlands? Het jy al van te vore vir n visum aansoek gedoen om na Nederland te reis?Did you ever reside in the Netherlands on the basis of a residence permit?Het jy al ooit van te vore in Nederland gebly op die basis van n verblyfsvergunning?

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Do you realise that you will be allowed to stay in the Netherlands or a max period of 12 month, counting from the date of entry into the Netherlands?Weet jy dat jy toegelaat gaan word om vir 12 maande in die land te bly vanaf jou aankoms datum in Nederland?Do you realise that you must return to your home country again after your au pair year?Besef jy dat jy na n jaar na jou land sal moet terugkeer?Please explain the main purpose of the au pair programVerduidelik asb die doel van die au pairgrogramPlease explain which kinds of tasks an au pair is allowed to doVerduidelik asb watter take is toegestaan vir n au pair om te doen.Please explain how many hours an au pair is allowed to work per day and per weekVerduidelik asb hoeveel uur per week en per dag n au pair mag werk.How much pocket money is an au pair entitled to?Hoeveel sakgeld mag n au pair ontvang?Is an au pair allowed to do any other work (paid or unpaid) in the Netherlands?Is n au pair toegelaat om enige ander werk in Nederland te verrig? ( betaald of onbetaald)What would you do if the host family would violate the rules of the au pair programme, for example if they would ask you to babysit for 10 hours per day?Wat sal jy doen as die die gasgesin die reels verbreek en jou vir 10 ure per dag vra om na die kinders te kyk?

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Do you understand that during your au pair year, you must stay in touch with your agency on a regular basis?Is dit vir jou duidelik dat jy gedurende jou au pairjaar, op n gereelde basis met jou agentskap in kontak moet bly?Are you aware of the fact that au pairs must report any change in their host family situation to your Dutch agency immediately (within 24 hours)Is jy bewus van die feit dat jy dadelik aan jou Nederlandse agentskap sal moet rapporteer as daar n veranderinge kom in die huidige gasgesin-omstandighede?( binne 24 uur)

This part must be filled out very carefully!! All information should be provided as stated in passport.

Die volgende deel moet noukeurig ingevul word. Alle informasie moet ooreenkom met wat in die paspoort staan

Detailed information for Visa & Flight information exactly as stated in passport!

Surname (s) / Van(ne)Names / NameBirth date . GeboortedatumBirth place / GeboorteplekBirth country /

Geboorteland

Civil status/ Siviele statusNationality

/Nasionaliteit

Passport number/ Paspoortnommer

Date of issue/ Datum van uitreiking

Valid until/ Geldig tot

Current address/ Huidige adres

Street and house number/ Straat en

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huisnommerCity / Stad/dorpPostal code/ PoskodeCountry / Land Phone number (with

landcode)Tel no met landkodeMobile number/

Selnommer

Email-address/E-posadres

Visit Dutch embassy in Cape Town or PretoriaBesoek die Ndl ambassade in Kaapstad of PretoriaFrom which airport do you need to fly?Van watter lughawe wil jy vlieg?

By sending in this form you declare that you have answered all the above questions truthfully and that you agree to take part in the NEDSA Au Pair Program./ By die instuur van hierdie vorm verklaar jy dat dat jy die vrae eerlik beantwoord het en dat jy instem om deel te wees van die NEDSA Au Pairprogram

Name/ Naam en Van:Date/Datum:

By completing this document, it does not mean that you have been automatically selected for the au pair program. There will be 2 more interviews.//Deur die invul van hierdie dokument, beteken nie dat jy outomaties gekeur is vir die au pairprogram nie. Daar sal nog 2 onderhoude volg.

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