Au-pair 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