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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)
61012

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?
citysmall towncountry

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)

Age

Nationality (required)

How many people in your family?

Last diploma?

Current Occupation?

Do you smoke? (required)
yesno

If yes, how many cigarettes each day?

If yes, would you refrain from smoking in the host family's home?
yesno

Do you have a driving license? (required)
yesno

If yes, since when?

Driving experience
goodsufficientpoornone

Do you have any dietary restrictions? If yes, please explain:

Do you have knowledge of first aid?
yesno

Do you have specific knowledge of childcare?
yesno

Can you swim?
yesno

What are your hobbies?

Do you suffer from allergies?

How would you rate your knowledge of the following languages:

French:
excellentgoodsufficientpoor

English:
excellentgoodsufficientpoor

Other language:

Rate knowledge of other:
excellentgoodsufficientpoor

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?
yesno

If not, which age do you prefer?

How long have you been taking care of children?

Do you have experience with disabled children?
yesno

Are you willing to care for a disabled child?
yesno

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?
yesno

Have you ever been an Au Pair before?
yesno

If so, in what country and for how long? Please specify place & date and provide references!

REFERENCES

Childcare Reference #1 name

#1 email address

#1 phone

Job position

Dates held

Childcare Reference #2 name

#2 email address

#2 phone

Job position

Dates held

Character Reference name

CR email address

CR phone

CR Relation

CR Since when