Au Pair Application Form
First Name
*
Last Name
*
Address
*
City
*
Postal code
*
Country
*
Phone number
Fax number
E-mail address
Sexe
Female
Male *
Date of Birth
*
Nationality
*
Religion
*
Brother(s)
*
Age(s)
Sister(s)
*
Age(s)
Your present occupation/profession
*
Do you have a criminal record or have ever had a criminal conviction?
*
What type of education was your last school/college/university?
*
Describe your childcare experience
*
Do you have a first aid certificate?
Yes
No *
What age group of children do you prefer to work with?
1-3
3-6
older
adults *
Are you willing to accept a family with a baby?
Yes
No *
Are you happy to do housework?
Yes
No *
Can you do laundry
Yes
No *
Can you help with cooking?
Yes
No *
Can you cook?
Yes
No *
At what level do you speak the language of the country you want to go to?
Basic
Lower Intermediate
Upper Intermediate
Good *
If you speak any other language, which do you speak?
*
Do you smoke?
Yes
No *
How many per day?
Are you prepared not to smoke in or near your host family’s house? (think about your answer carefully, you could be sent home if your host family catches you smoking when you promised not to smoke
Yes
No *
Do you have a driving license?
Yes
No *
Since when?
Are you prepared to drive in your host country?
Immediately
after some training
after a lot of training
Would you accept a family with pets?
Yes
No *
Do you have a valid passport?
Yes
No *
What is your passport number?
Do you have any physical disability, handicap or allergy?
Yes
No *
If yes, what?
What is your general state of health?
*
What is your height
*
What is your weight
*
Are you single
Yes
No *
Can you swim
Yes
No *
Have you lived away from home before?
Yes
No *
If yes, please describe where
Do you suffer from homesickness?
Yes
No *
If yes, do you think you can overcome this when you are living in another country with a host family?
Yes
No *
Which country would you like to go to?
*
Where do you want to live?
City
Town
Village
Farm
Other *
Would you accept a family of different ethnic origin or race?
Yes
No *
Would you accept a family with a different religion if they lead a European lifestyle?
Christian
Muslim
Hindu
Jewish *
Would you accept a single parent family?
Single Mother
Single Father
No Single Parent Family *
Do you want to attend a language course or pursue another study?
Yes
No *
When can you start as an Au Pair?
*
Until what date (approximately) would you like to stay?
*
Other details or wishes
*
I have read, understood and agree to the conditions mentioned in the au pair agreement and information provided by AuPairs Worldwide, and confirm that the above given information is true. Withholding any information that should have an impact on my stay as an au pair with a host family can lead to my dismissal as an au pair and I understand that I can be sent home immediately.
I agree *