EmailMeForm
Au Pair Application Form
Personal Questions
Name (s)
First
Middle
Last
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country of origin
Telephone
Mobile
E-mail
Skype
Religon
Nationality
Date of Birth
Age
Father’s occupation
Mother’s occupation
Do you have any brothers or sisters?
General Questions
Where would you like to be an Au Pair?
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia & Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
The Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Turkey
Ukraine
United Kingdom
When would you like to start?
DD
/
MM
/
YYYY
How long would you like to be an au pair?
Preferred region?
Big city
Small town
In the country
Don’t mind
Do you have a criminal record?
Are you in good health?
Do you have any allergies?
Do you have any special dietary needs?
Do you smoke? if so How many a day? and Would you agree not to smoke in the family’s home?
Would you accept a family of any ethnic origin?
Would you accept a single parent family?
Single mother
Single father
Both
None
Do you have any experience of children aged:
0 – 2
3 – 5
6 – 9
10 and over
Are you willing to work with babies?
State any childcare experience you have:
Do you have a driving licence? if so, When did you pass?
Would you drive in your host country?
Can you swim?
Are you willing to do housework (cooking, washing, ironing. vacuuming ,etc.)
Languages & Qualifications
English level:
Basic
Intermediate
Good
Fluent
Other languages spoken:
Do you have any First Aid or other certificates (lifesaving, music, Scouts etc.?)
Additional information
Additional information
Photo upload
Photo upload
By clicking submit, you declare that all the details provided are correct.