Please fill out the form below and submit to apply for an Au Pair position:
Your First Name (required)
Your Last Name (required)
Preferred Country (required)
Length of stay (months)
Earliest date I can depart:
Latest date I can depart:
Latest date I have to return to my home country:
Which area do you prefer?
Your Email (required)
Your Address (required)
Address & Street:
City, State, Zip, Country:
Your Phone #'s
Landline Phone #:
Mobile Phone #:
Your Skype ID
Date and Place of Birth (required)
How many people in your family?
Do you smoke? (required)
If yes, how many cigarettes each day?
If yes, would you refrain from smoking in the host family's home?
Do you have a driving license? (required)
If yes, since when?
Do you have any dietary restrictions? If yes, please explain:
Do you have knowledge of first aid?
Do you have specific knowledge of childcare?
Can you swim?
What are your hobbies?
Do you suffer from allergies?
How would you rate your knowledge of the following languages:
Rate knowledge of other:
Are you experienced in childcare of children in the following ages?
baby9-12 months1-3 years3-6 years6-10 years
Are you happy to care for any age?
If not, which age do you prefer?
How long have you been taking care of children?
Do you have experience with disabled children?
Are you willing to care for a disabled child?
Would you prefer to be in a home with 1, 2, 3 or 4 children?
Are you willing to work with a single mother or single father?
What experience do you have in domestic work? (please specify)
Do you like animals?
Would you look after animals?
Have you ever been an Au Pair before?
If so, in what country and for how long? Please specify place & date and provide references!
Childcare Reference #1 name
#1 email address
Childcare Reference #2 name
#2 email address
Character Reference name
CR email address
CR Since when
Your Name (required)