Au Pair Booking Form

AU PAYS DES LANGUESTel 05 33 89 18 00 - Email : contact@aupaysdeslangues.fr

www.aupaysdeslangues.fr

Personal information

First name & Last nameMlle Cécile Marinier

Photo d'identité

Address10 rue de la SciasserieAthée sur Cher 37270France

Date of birth13/12/1998

Age21

SexeFéminin / Female

Your nationalityfrench

Home phone number0247356038

Mobile phone number0778149672

Email addresscecile.marinier98@orange.fr

ID skypelive:cecile.marinier1998

Destination country N°1Australie / Australia

Destination country N°2Irlande / Ireland

Destination country N°3Islande / Iceland

What is your English level?B1 - Intermédiaire / B1 - Intermediate

Desired start date01/09/2020

Maximum return date01/07/2021

What kind of position are you looking for ?Garde d'enfants + tâches ménagères / Traditional childcare

Informations concerning your Au Pair stay

Do you accept following positions?25-30h par semaine / 25-30h a week30-35h par semaine / 30-35h a week

Where do you accept to live?

AU PAYS DES LANGUESTel 05 33 89 18 00 - Email : contact@aupaysdeslangues.fr

www.aupaysdeslangues.fr

Dans une petite ville / Small townPrès d'une grande ville / Near cityDans une grande ville / Major city

Do you have experience with babies (3 to 12months)?Non / No

Do you accept to take responsibility of an infantchild by yourself?Non / No

Tick experiences you have had with childrenPréparer des repas simples / Preparing simple mealsCoucher le/les enfants / Put the kids to bedDonner le bain/douche / Bath the kidsFaire des activités manuelles (dessins, pate à modeler...) / Do manual activities (drawing, play-dough activities

...)Faire des jeux extérieurs (balades, sports, jeux...) / Do outdoor activities (moving around, sports, games...)Aide aux devoirs / Homeworks helpConduire / Emmener les enfants à l'école / Take children to school

Indicate children age groups you would like to take care of4-6 ans / 4-6 years old7-10 ans / 7-10 years oldplus de 10 ans / over 10 years old

Do you have any qualification in connection withchild-caring ?Non / No

Would you accept a family with more than 3children ?Peut-être / Maybe

Do you accept to take care of disabled childrenor with special needs ?Oui / Yes

Do you accept single-parents family ?Mère célibataire / Single mother

Do you accept a bilingual family ?Peut-être / Maybe

Would you accept to take care of an elderlyperson ?Non / No

Would you accept a family that ask only forhousekeeping?Non / No

Do you accept the following chores ?Lessive (machine à laver) / LaunderingAspirateur / VacuumingRepassage / IroningLave-vaisselle / Dish-washerMénage léger / Light cleaningCuisine / Cooking

Do you accept to work more for more money ?Oui / Yes

Could you do pet-sitting?Oui / Yes

What are your hobbies ?

AU PAYS DES LANGUESTel 05 33 89 18 00 - Email : contact@aupaysdeslangues.fr

www.aupaysdeslangues.fr

I've been playing handball for ten years. I love sports and outdoor activities. I listen to a lot of music, I made somewhen I was younger. I like to travel, read and especially take care of children!

Introduction letter to the families

Introduction letter to the familiesHello! I'm a student in linguistics who wants to take a year off from my studies, so I chose to become an au pair.That's why you're reading this message! My name is Cécile, I am 21 years old, I'm French so my native language isFrench. I learned English at school so I'm doing fine but I hope to improve it this year. I am a very active and sportygirl. I like to play, laugh and have fun! I chose to become an au pair because I love children. I usually get along verywell with them.I regularly babysit children around my house, I also help them with their homework. My professional project is tobecome a teacher, I would love to help your children with their homework. I am serious and diligent. I have beenplaying handball for 10 years. In my club I coach young children and we have a lot of fun. In my family I have youngcousins that I take care of every holiday. We do a lot of handicrafts, play board games, play outside when theweather permits.What I love in life is traveling. I love discovering new cultures and I would be happy to share mine with you.Becoming an au pair is a unique experience for me. I am very motivated, I am helpful and I will be discreet so asnot to disturb you. I would love to find a family where I feel comfortable, that they appreciate me and that we havea good time together. I am not a difficult person, I am very open-minded.I would be happy to come and take care of your children and treat them with attention. I look forward to hearingfrom you.Best wishes,Cécile

Childcare references

Childcare reference n°1

Name of the person who asked for your servicesLaurie Seguin

His/Her phone number0789516686

His/Her email addressseguin.laurie123@gmail.com

First name and age of the children cared forAnouck (6) Carmen (8)

For how many time did you took care of thechildren6h/week during 1 year

What were your responsibilities toward children ?Préparer des repas simples / Preparing simple mealsCoucher le/les enfants / Put the kids to bedDonner le bain/douche / Bath the kidsFaire des activités manuelles (dessins, pate à modeler...) / Do manual activities (drawing, play-dough activities)Faire des jeux extérieurs (balades, sports, jeux...) / Do outdoor activities (moving around, sports, games...)Aide aux devoirs / Homeworks helpConduire / Emmener les enfants à l'école / Take children to schoolGestion des colères / caprices / Management of the angry behaviors / of the whims

AU PAYS DES LANGUESTel 05 33 89 18 00 - Email : contact@aupaysdeslangues.fr

www.aupaysdeslangues.fr

What were your responsibilities toward housekeeping tasks?Ranger la chambre des enfants / Tidy up kids bedroom

Checked by Au Pays Des LanguesApproved

Comments from Au Pays Des Langues

Childcare reference N°2

Name of the person who asked for your services

His/Her phone number0612910249

His/Her email address

First name and age of the children cared forMila (12) Marceau (10)

For how many time did you took care of thechildrenevery holliday (3 months per year)

What were your responsibilities toward children ?Préparer des repas simples / Preparing simple mealsCoucher le/les enfants / Put the kids to bedDonner le bain/douche / Bath the kidsFaire des activités manuelles (dessins, pate à modeler...) / Do manual activities (drawing, play-dough activities)Faire des jeux extérieurs (balades, sports, jeux...) / Do outdoor activities (moving around, sports, games...)Aide aux devoirs / Homeworks helpGestion des colères / caprices / Management of the angry behaviors / of the whims

What were your responsibilities toward housekeeping tasks?Ranger la chambre des enfants / Tidy up kids bedroomPasser l'aspirateur / Vacuuming

Checked by Au Pays Des LanguesApproved

Comments from Au Pays Des Langues

Additional informations

Current Studies/Occupationbac + 3

What is your mother's profession ?manager of bed and breakfast and gîtes

What is your father's profession ?farmer and teacher

D. Fontanie

AU PAYS DES LANGUESTel 05 33 89 18 00 - Email : contact@aupaysdeslangues.fr

www.aupaysdeslangues.fr

Do you have sisters and brothers ?Oui/Yes

Age and numbers of brothers and sisters2 sisters: 18y and 22y

What is your religion ?atheist

Do you have to devote time to church ?Non / No

Do you have the driving licence ?Oui / Yes

Indicate your driving licence completion date08/08/2017

Do you smoke ?Non / No

Do you have any dietary requirements ?Non / No

Can you swim ?Oui/Yes

Are you comfortable caring for children aroundwater ?Oui/Yes

Emergency ContactHélène et Eric MARINIER10 rue de la Sciasserie, 37270 Athée sur Cher, Francehelene.eric.marinier@orange.fr

What is your height (cm) ?175

What is your weight (kg) ?68

Additional informations

Comments from Au Pays Des Langues

RÉPUBLIQUE FRANÇAISEMINISTÈRE DE LA JUSTICE

Direction des affaires criminelles et des grâcesCasier judiciaire national

44317 NANTES CEDEX 3

BULLETIN NUMÉRO 3

Le magistrat, chef du service du Casier judiciaire nationalEric SERFASS

Réf : 20072109634//1816/000000000/INTERNET/000/N/N

Bulletin délivré le 12 mars 2020

Vérifiable surhttps://casier-judiciaire.justice.gouv.fr/verif· date de délivrance 12/03/2020· heure de délivrance 18:16· identifiant document 20072043634B3· clé de contrôle 4D787C24

CECILE MARINIER10 RUE DE LA SCIASSERIE37270 ATHÉE SUR CHER

Résultat à vérifier6FEA4C22 C77E1E48 C7687F84 619F42D89DA6E23D 94597DC3 6507CA25

IDENTITÉNom MARINIERPrénom(s) CECILESexe FémininDate de naissance 13 décembre 1998Lieu de naissance ANCENIS (44)Nom d’usage MARINIER

Relevé des condamnations devant figurer au bulletin numéro 3 (article 777 du Code de procédure pénale)

En l’absence de condamnation devant figurer au bulletin numéro 3, celui-ci comporteune barre transversale (article R. 84 du Code de procédure pénale)

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AMITY INSTITUTE BUILDING INTERNATIONAL FRIENDSHIP & CULT URAL UNDERSTANDING

THROUGH TEACHING EXCHANGE

Intern Program - Health Evaluation Form

Name of Intern Program Applicant: __ ca~ ..... " ..... GLh ....... · ............ .....__/IT\ .............. a ........... x_i.._m .......... ~ .... e ...... &......_ ________ _

PART l:To be completed and signed by the Intern Program Applicant.

Please mark all vaccines that you have received:

BJ Diphtheria/Pertussis/Tetanus ~Tetanus (Adult) [81 Measles (Rubeola) ~Mumps ~Polio D ChickenpoxN aricella ~ Hepatitis B g) Hemophilus B ~Bacillus Calmette-Gue1in (for Tuberculosis):

Note: Immunization requirements in the U.S. vary from state to state. At this time, you are not required to get the vaccines listed above if you have not already done so. You will be notified by the Host School of any vaccine requirements prior to your arrival in the U.S.

1. Have you recently been tested for Tuberculosis? D Y es IX]No la. If yes, what was the result? D Positive D Negative NOTE: If test result is positive, chest x-ray or clearance letter from your physician is required.

lb. Chest x-ray result: D Have TB D Do not have TB Date of chest x-ray: -------·2. Do you have any allergies? DY es IX]No

lfyes, please list below.

3. Do you have any dietary restrictions? 0 Yes ~No If yes, please describe.

4. Do you take any prescription medication, excluding birth control, on a regular basis? D Y es 18;:]No If yes, please state the medication name, dosage, and condition that you are being treated for.

5. Do you currently or did you ever have any serious health problems, conditions, or symptoms, including psychiatric or mental disorders, for which you have or should have received treatment?[]Y es ~No

If yes, please explain in detail.

6. Have you ever been hospitalized? DY es jg] No Ifyes, explain why and when.

Page 1

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