Au-pair/ nanny form

I would like to work as au-pair in *

for /months/

Other countries or specific areas of interest

Would you accept a family who lives in the countryside *

Yes
No

Would you like to start as soon as possible

Yes
No

If No, when would you like to start *

First name *

Last name *

Sex

Female
Male

Date of birth *

Phone *

Current address *

Current city *

Current zip/postal code *

Current country *

Nationality/citizenship *

E-mail address *

Do you have any brothers or sisters

Yes
No

If Yes, how many and what are their ages

Have you worked with children before

Yes
No

If Yes, what year´s, what age were they at that time

Do you have a driving licence and the ability to drive a car

Yes
No

Do you have a criminal record

Yes
No

Do you smoke

Yes
No

Education: High school, College school From - To

Other information about education

Profession as (name the last three employments) From - To

Have you worked as au-pair or nanny before

Yes
No

If Yes, tell us what country and when

Do you have any references from those families, please add name and phone numbers

Please add another contact person that knows you

Your personality and why you wish to be an au-pair.

Are you allergic against something, if yes, what

What child diseases have you had

Have you had any serious sickness or handicap lately , if yes what

Can you send us a medical certificate if required

Yes
No

What languages do you speak and at what level: Mother tongue, Advanced, Intermediate, Basic

I would be interested in a language class to improve my:

Can you swim

Yes
No

Are you a vegetarian?

Yes
No

Do you like pets

Yes
No

Write a short "Dear family"-letter to your future host family where you tell something about your hobbies, personal interests and future plans.

The best time to reach me is

AU-PAIR WORLD AGENCY SWEDEN

Answering questions in the form and send