REGISTRATION SELF-MATCH FORM

Please fill out this form electronically before printing

Au Pair information
Name (first, middle and last name) Nicole Novais
Nickname
Nationality Brazilian
Date of birth 24/03/1998
Place & Country of Birth Blumenau, Santa Catarina, Brazil
Age 25

Host family information

Names of host parents Simone van Kralingen and Rutger Lelij
Address
Street address van Oldenbarneveltlaan 21
Zip code 2012 PA
City Haarlem
Country The Netherlands
Children names and ages Bo 7 - Jim 5 - Fleur 5
How did you meet each other? aupairworld.com
Why did you select this family? Because I felt that the family is welcoming and heartwarming.

Basic personal information

Mobile number (+country code) +5547997708557
Home telephone number (+country code) +554733392639
Email address niicolenovais@gmail.com
Skype username
Facebook / Instagram page link
Address in home country
Street address João Baptista Beduschi, 200
Town/City Blumenau
Zip code 86055-090
Region Santa Catarina
Country Brazil
Address abroad (only if currently living abroad)
Street address
Town/City
Zip code / Region
Country
Civil status Single
(single, in a relationship, married, divorced)
Do you have children? No
Do you live on your own if not, please describe I live with my mother and my father.
with who you live together.
How many siblings you have and what they None
do?
Passport number GB322357
Date of passport issuing 27/01/2020 Date of passport expires 26/01/2030
City of passport issuing Itajaí
Hold a residence permit Yes No ------ Country: Expires at:

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Closest Dutch Embassy to you (if applicable) São Paulo, SP, Brazil
Nearest international airport to you Florianópolis International Airport – Hercílio Luz
Which transportation will you use to travel to Plane
the Netherlands

Personal information

Can you ride a bike? Yes No

Can you swim? Yes No
Are you in good health? Yes No
(if no, please explain)

How often have you been ill over the last year? I had a cold once.
Do you use medicine? Yes No
(if yes, please explain)

Do you follow a specific diet (e.g. vegetarian)? No

Do you suffer from any allergies? Yes No
(if yes, please explain)

Are you vaccinated against covid? Yes No

Do you smoke? Yes No

Do you practice any religion? No

Why would you like to be an au pair in the Netherlands?

I would like to be an au pair in the Netherlands because it seems to be an incredible place to live and have this
experience as an au pair.

What are your hobbies?

Skiing and going to the gym.

What will you do, in your spare time during the au pair program?
I would like to travel as much as possible, and make friends to spend time with them.

Do you know anyone in the Netherlands or other countries in Europe?

If yes, please give their contact information (name, relation to you, phone, email, address)
Yes No

What are your plans for after your au pair year in the Netherlands?
After my au pair year in the Netherlands I want to come back to Brazil to start working with International Trade.

Agreement with host family

On which date do you plan to start the program? 24/07/2023

On which date do you plan to end the program? 24/07/2024
How much pocket money will you receive from the family each € 340
month?
The au pair shall be entitled to remuneration in respect of the work that he or she carries out for
the family. This remuneration shall take the form of a personal allowance and shall not take the
form of a salary, as the au pair is not permitted to carry out any work within the meaning of the
Labour Act for Aliens [Wet arbeid vreemdelingen, Wav]. The allowance must total no more than
€ 340 per month.

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Agreement with host family

How much money will your host family contribute to an au pair € 400
course, for example a language course, for you?

What other benefits does your host family offer you?

(bicycle, mobile phone, museum card, transport card, etc.) Bicycle.
When will you have paid holiday/vacation time?
Au pairs are entitled to 2 weeks of paid holiday per annum.
Accorded with the host family.
Will you go on holiday with the family? No.
Au Pairs are not allowed to preform au pair duties outside of the Netherlands.

How many hours per week will you work for the host family? 30
Under the Dutch law au pairs are allowed to work maximum of 30 hours per week.

Describe your au pair schedule (duties, total hours per day)

Monday 6:45 - 9:30 14:00 - 17:30
Tuesday 6:45 - 9:30 14:00 - 17:30
Wednesday 6:45 - 9:30 12:15 - 18:00
Thursday: 6:45 - 9:30 14:00 - 17:30
Friday: 8:15 - 9:00
Saturday:
Sunday:

Total hours per week: 28 hours

The au pair shall be permitted to work no more than eight hours per day, up to a maximum of 30 hours per week, in exchange for board, lodging and an allowance.
The au pair shall be entitled to no less than two free days, as well as two free evenings per week. The au pair shall only be permitted to carry out light domestic work.
Examples of this are tidying up the nursery, washing and ironing the children’s clothes, preparing light meals and occasionally running errands. The au pair is not
allowed to perform activities for persons who need specialised care, which requires special skills. These are for example activities for which medical knowledge or
medical training is necessary or required.

Please specify the light household chores:

Travel expenses agreement

Who will pay for your travel to pick up documents or to the
embassy? (if applicable) Me
How will you travel (bus, plane, train, car, etc.) and will pay for your I will travel to the Netherlands by plane,
travel to the Netherlands at the beginning of the au pair year? and the host family and I will split the costs.
Who will pay for your travel at the end of your agreement if you will
travel to your home country? Will discuss with the family.
Who will pay for your travel at the end of your agreement if you will
not travel to your home country, but instead to another country? Wil discuss with the family.
(for example, if you plan to au pair again elsewhere)

Au pair experience
Have you been an au pair before or now? Yes No
In which country/countries? United States
Start and end date September 10th 2020 to June 10th 2022
Name(s) host family Kristen and Bryan Maguire
Phone number host family (+country code) +1-917-226-5276
Email address host family kristenmaguire@gmail.com

General working experience

Employer Job description Hours per week Start date End date Reference included
JTT Soluções Financial Assistant 45 10/05/2017 26/05/2020 Yes No
Logísticas LTDA
Yes No

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General working experience

Yes No
Present occupation No current ocupation.
Work, study, other (explain)

Study
Highest Level of Education Completed (please share diploma)
Undergraduate

Comments and questions

In case of a RE-MATCH – Describe the reason, you are in a re-match, name of your current agency and the name of
your contact person.
Reason re-match

Name current au pair agency & contact person: name and contact details

Are you registered in the Netherlands: Yes No

If yes, what is your BSN number

Have you arranged DigiD: Yes No

Do you have a basic health insurance: Yes No

If yes, with which insurance company

Do you receive Care allowance (Zorgtoeslag): Yes No

Have you undergone the tuberculosis test: Yes No

If yes, when and where

I hereby declare that all information I gave is correct and any following application documents are correct.

Name, last name & Signature Date City

09/05/2023 Blumenau, Santa Catarina, Brazil

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