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RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China 1 / 9 Au Pair Application Form Dates Earliest arriving date 20 june 2016 Latest arriving date 1 july 2016 Length of Stay(3-12months) 3 months Basic Infomation First Name Furio Last Name Dalla Palma Full Name Furio Hermann Dalla Palma Male/Female male Date of Birth(mm/dd/yyyy) 04/21/1998 Place of Birth Lavarone, TN, Italy Nationality Italian Religion Trentino Passport No. AA2569079 Married/Single/Divorced/Separated single Height& Weight (cm& kg) 1,83 cm 70 kg Have you driving License(Yes/No) not yet, but i should from the beginning of june)

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Page 1: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

1 / 9

Au Pair Application Form

Dates

Earliest arriving date 20 june 2016 Latest arriving date 1 july 2016 Length of Stay(3-12months) 3 months

Basic Infomation

First Name Furio Last Name Dalla Palma Full Name Furio Hermann Dalla Palma Male/Female male Date of Birth(mm/dd/yyyy) 04/21/1998 Place of Birth Lavarone, TN, Italy Nationality Italian Religion Trentino Passport No. AA2569079 Married/Single/Divorced/Separated single Height& Weight (cm& kg) 1,83 cm 70 kg Have you driving License(Yes/No) not yet, but i should from the beginning of june)

http://www.aupairshanghai.org/
Page 2: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

2 / 9

Family Info

Family Simple Introduction

Father

Name: Michele Dalla Palma

Occupation:journalist

Mother Name:Valentina Musmeci Occupation:teacher, writer

Are you currently living with your

parents?

Do you have any siblings?(If yes,

specify the number and age) Brothers Attila Dalla Palma, 23

Sisters Morgana Dalla Palma, 22

Education(From high school to current education background)

Education (qualification/major)

Name of the

school/university/college Starting year Finishing year

high school 2012 2017

Language

Mother Tongue italian Chinese level (Zero/Beginner/Intermediate/Advanced

)

beginner-intermediate

English Level (A1,2/B1,2) Other languages(and level)

english b2-c1 german b2

Hobbies & Interests

Describe your hobbies

I like music a lot, and I like to play a little bit of guitar, I play the drums and sing in a band. I like drawing and reading and also theater activities. Which sports do you like? I have been doing parkour from 3 years and I would

like to start doing kung fu.

http://www.aupairshanghai.org/
Page 3: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

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Do you play any instruments? (If yes,

please specify) i playthe drums, sing and play a bit of guitar.

Childcare Experience

Do you have any experience with

children? yes

If yes, please specify the age group and the experience I have been babysitting with kids from 5 to 14

General Questions

Do you smoke? no Would you mind the host family

members smoking at home? no

Do you swim? yes Do you like animals? yes Do you have any work experience?

(If yes, please specify) yes

Work experience

Name of working place Working period of time Job description lago di levico from july until the middle

of august 2015 lifeguard

What do you do at present? student

Medical Information

Can you provide a Medical

Certificate (within 6 months)?

yes

Do you have any physical or medical

disabilities? (If yes, please specify)

no

Do you take medications regularly?

(If yes, please specify)

no

Do you suffer from any allergies?

no

http://www.aupairshanghai.org/
Page 4: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

4 / 9

Are there any specific comments

you would like doctors to know in

an emergency situation?

no

Motivation

Have you been to China?(Yes/No), If

Yes, How long and

When/Where(HK/Macau/Mainland)

?

yes in beijing for three weeks in 2013

Why do you choose China as your

destination? shanghai, hongkong, beijing,

What do you expect from the host

family? to be kind with me and to threat

Do you want to attend a language

school to learn Mandarin? yes, a priority

What are the main factors for you to

choose the host family?

(Your placement preference)

intellectual persons, who are disposed to help me with my chineese speaking

Dear family letter

Write a letter to your future host family below:

Dear Host family: thank you for the occasion you are giving me. we don’t know each other, but i am aleady grateful

to you for everything you are doing helping me to come to China. I can’t wait to meet a new warm-hearted family which will host me and with which I’m going to have a lot of fun. I hope I will help you with your engliish. and that we can have an exchange on every level, from culture to personal ways of seeing life. I’m looking forward to know about you.

Furio Dalla Palma.

亲爱的接待家庭：

感谢你们给我这个机会。我们不认识，但是我很感谢一切你们为我做的事情能够让我来

到中国。我等不及想见到你们这个温暖而有趣的大家庭。我希望我能够帮助你们孩子英

语，我们也能一起文化交流，从文化到个人对生活的观点的看法中交流。

我期待你们的消息。

Pictures

http://www.aupairshanghai.org/
Page 5: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

5 / 9

Please paste 3-5 pictures on this page, including 1 passport photo and some photos with your family, friends and children(Kind of like student style and more nature of your pictures is better, coz Chinese families most of them are traditional, especially they hopes their kids can get some

good habits and anything from you which is role-model)

http://www.aupairshanghai.org/
Page 6: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

6 / 9

http://www.aupairshanghai.org/
Page 7: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

7 / 9

http://www.aupairshanghai.org/
Page 8: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

8 / 9

http://www.aupairshanghai.org/
Page 9: Au Pair Application Form · Certificate (within 6 months)? yes Do you have any physical or medical disabilities? (If yes, please specify) no Do you take medications regularly? (If

RaingArt tofriend Au Pair Tel: +86 21 6278 0292 Email:[email protected] Skype: tofriend.com www.tofriend.com Address.: 525 Yishan Rd, Xuhui district, Shanghai, China

9 / 9

http://www.aupairshanghai.org/

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