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Wanderlust Exchange Au Pair Application Form

Dear Au Pair candidate,
Please fill out the application form for the first step of your adventure to China! It takes about 10-15 minutes and the information will be only used for the family to get to know you.

IMPORTANT: Do not close the page until you finish the form, otherwise you will need to type in your information again.
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1.
Earliest arriving date
最早来华时间
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2.
Latest arriving date
最迟来华时间
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3.
Longest of Stay(3-12months) in China
在华时间

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4.
Basic Information
基本信息
First Name 名字
First Name 名字
Last Name 姓
Last Name 姓
Full Name 全名
Full Name 全名
Male/Female 性别
Male/Female 性别
Date of Birth (mm/dd/yyyy) 出生日期
Date of Birth (mm/dd/yyyy) 出生日期
Place of Birth 出生地
Place of Birth 出生地
Nationality 国籍
Nationality 国籍
Religion 宗教
Religion 宗教
Passport Number 护照号码
Passport Number 护照号码
Married/Single/Divorced/ 婚姻状况
Married/Single/Divorced/ 婚姻状况
Height& Weight (cm& kg) 身高体重
Height& Weight (cm& kg) 身高体重
Do you have a driving License(Yes/No) 你有驾照吗？
Do you have a driving License(Yes/No) 你有驾照吗？
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5.
Family Information
家庭信息
Father’s name and occupation 父亲
Father’s name and occupation 父亲
Mother’s name and occupation 母亲
Mother’s name and occupation 母亲
Home address 家庭住址
Home address 家庭住址
Postal code 邮政编码
Postal code 邮政编码
Are you currently living with your parents? 是否和父母住在一起？
Are you currently living with your parents? 是否和父母住在一起？
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6.
Do you have any siblings? (If yes, please specify relationship and age)
你有兄弟姐妹吗？
Yes 有
No 没有
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7.
Contact Information
联系方式
Phone at home/work (National code+area code +number)
Phone at home/work (National code+area code +number)
Mobile (National code+area code+number)
Mobile (National code+area code+number)
Email (essential)
Email (essential)
How did you know about our program?
How did you know about our program?
Skype (very important)
Skype (very important)
Wechat: (very important)
Wechat: (very important)
Emergency contact person’s cellphone number
Emergency contact person’s cellphone number
Your relationship with the emergency contact person
Your relationship with the emergency contact person
The Best Time to Contact you?
The Best Time to Contact you?
Address of your current living
Address of your current living
Postal Code
Postal Code
City&State (time difference uses)
City&State (time difference uses)
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8.
Education Background 1 (From the highest degree)
教育背景
学位/专业Education (qualification/major)
学位/专业Education (qualification/major)
校名School name
校名School name
起始 Starting year
起始 Starting year
结束 Finishing year
结束 Finishing year
9.
Education Background 2 (From the highest degree)
教育背景2
学位/专业Education (qualification/major)
学位/专业Education (qualification/major)
校名School name
校名School name
起始 Starting year
起始 Starting year
结束 Finishing year
结束 Finishing year
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10.
Language
语言能力
Mother Tongue 母语
Mother Tongue 母语
Chinese level 中文水平
Chinese level 中文水平
Would you like to attend a language school to learn Mandarin? 你想参加中文课程吗？
Would you like to attend a language school to learn Mandarin? 你想参加中文课程吗？
Other languages (and level) 其他语言
Other languages (and level) 其他语言
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11.
Hobbies & Interests
兴趣爱好
Please describe your hobbies in details 请形容下你的兴趣爱好
Please describe your hobbies in details 请形容下你的兴趣爱好
Which sports do you like? 你喜欢什么运动？
Which sports do you like? 你喜欢什么运动？
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12.
Do you play any instruments?
你会弹奏乐器吗?
Yes (what instrument) 是
No 不会
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13.
Do you have any experience with children?
你有照顾孩子的经验吗？
Yes 有
No 没有
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14.
Childcare Experience 1 孩童看护经验1
Please describe your childcare experience in details
Range of children age 儿童年龄
Range of children age 儿童年龄
Working period of time 工作时长
Working period of time 工作时长
Job description 工作描述
Job description 工作描述
15.
Childcare Experience 2 孩童看护经验 2
Please describe your childcare experience in details
Range of children age 儿童年龄
Range of children age 儿童年龄
Working period of time 工作时长
Working period of time 工作时长
Job description 工作描述
Job description 工作描述
16.
Childcare Experience 3 孩童看护经验 3
Please describe your childcare experience in details
Range of children age 儿童年龄
Range of children age 儿童年龄
Working period of time 工作时长
Working period of time 工作时长
Job description 工作描述
Job description 工作描述
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17.
What is your preferred range of children’s age?
你希望照顾多大年龄段的孩子？
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18.
Do you smoke? Would you mind the host family members smoking at home?
你吸烟吗？你介意你的寄宿家庭吸烟吗？
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19.
Do you have a preference of the host city/cities? If yes, are you open to other cities?
有偏向的城市吗？如果有，能接受其他城市吗？
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20.
Do you have any other requirements from the host family of China?
你对寄宿家庭有什么要求吗？
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21.
Do you swim?
你会游泳吗？
Yes 会
No 不会
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22.
Do you like animals?
你喜欢动物吗？
Yes 喜欢
No 不喜欢
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23.
Do you have any dietary restrictions?
你有什么忌口吗？
Yes (please specify) 有(请说明)
No 没有
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24.
Do you have working experience?
你有工作经验吗
Yes 有
No 没有
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25.
Work Experience 1 工作经验 1
Please describe your work experience in details
Name of working place 工作地点
Name of working place 工作地点
Working period of time 工作时长
Working period of time 工作时长
Job description 工作描述
Job description 工作描述
26.
Work Experience 2 工作经验 2
Please describe your work experience in details
Name of working place 工作地点
Name of working place 工作地点
Working period of time 工作时长
Working period of time 工作时长
Job description 工作描述
Job description 工作描述
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27.
Can you provide a Medical Certificate (not older than 6 months, we will also provide you a medical report form if needed)?
你可以提供健康证明吗？
Yes 可以
No 不行
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28.
Do you take medications regularly?
(If yes, please specify)
你有规律性用药吗？
Yes 有
No 没有
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29.
Do you suffer from any allergies?
(If yes, please specify)
你有过敏源吗？
Yes 有
No 没有
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30.
Are there any specific comments you would like doctors to know in an emergency situation?
(If yes, please specify) 有特殊医嘱吗
Yes 有
No 没有
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31.
Have you been to China before? (If yes, please specify)
你之前有来过中国吗？
Yes 有
No 没有
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32.
Why do you choose China as your destination?
为什么选择中国作为你的目的地？
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33.
What’s the main reason that you would like to be an au pair?
你想做互惠生的主要原因是什么？
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34.
What do you expect from the host family?
你对寄宿家庭有什么期望？
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35.
How are you going to spend your free time in China?
闲暇时间你打算在中国怎么度过？
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36.
When will you be available to talk with the host family by Wechat?
你什么时间方便和家庭面试？
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37.
Please attach ONE picture which shows the best of you!
选择文件( 不超过4M )
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38.
Please write a letter to your future host family below.
给家庭的一封信

Dear Host Family,
 （at least 100 words）
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