Personal	Health
Surname First name: Date of Birth: Nationality: Single Married Height: cm. Weight: kg. Home address: Telephone (+code): Other contact address: telephone (+code): Social security number:	State of healt: GoodAverageBad Is there any work which, for reasons of health, you would find difficult?: Any special dietary requirements? Do you have any health problems, or are you taking any medication? Yes No If yes, what kind?: Briefly describe your personality: Do you have a current driving license? Yes No Have you ever been convicted of a criminal offense? Yes No

Education

Current level of study: Bac+other:

From

To

Name of school / university

Exams passed & grade

Which subjects are you studying this year?

Of the subjects you are studying, which one do you find most interesting?

University or school:

Address:

Director of studies:

Languages
To find out what your level of comprehension is, please click on written skills or Oral comprehension

English	Oral comrehension	1 2 3 4 5 6 7 8 9 10
	Written skills	1 2 3 4 5 6 7 8 9 10
Numbers of years of study:
Other languages		1 2 3 4 5 6 7 8 9 10
		1 2 3 4 5 6 7 8 9 10

Computer systems and languages masterd:

Interests

Experience

Describe tasks/areas of responsibility entrusted to you in precious work-placements or jobs:

Company/Activity	From/to	Responsibilities
	/
	/
	/
	/
	/
	/

Experience gained:

Have you ever been abroad? Yes No If yes, please give details:

Your Future

At the end of my studies, I want to be capable of (skills): What job are you aiming for? Type of company:

This work experience

Tick your chosen Field

Hotel/catering
Tourism
Secretarial
Arts/Culture
Sports
Social activities
Specialised education
Marketing/Commercial
Publicity/Communication
Import/Export
Accounting/Finance
Industry
Quality/Certification
Other:

Is your training compulsory? Yes No

Dates available to work: From to or From to Length of stay: weeks

Should we arrange your accommodation? Yes No

In hotel In a host-family with half-board accommodation In a student village Studio

Within your chosen field, what specific skills/knowledge would you want to use?

Many places are non-smoking. By sending this document, you accept not to smoke in such places. I hereby certify that the information given in connection with this application is true and correct.

Back