Living aupair general form

Application form for an Aupair placement
Personal Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Fiscal Code or Social Security Number
Birth Date

MonthDayYear
Marital status
Age
E-mail
Skype
Phone Number

Area CodePhone Number
Cell

Area CodePhone Number
Nationality
Religion
Information about your placement
How long do you plan to stay?
Earliest arrival date

MonthDayYear
Latest arrival date

MonthDayYear
When do you have to quit your au pair job at the latest?

MonthDayYear
Have you ever been an au pair before?

yesno
If yes, in which countries?
Would you like to be placed as:

Au PairDon’t mindMother’s help
Preferred area

No preferenceRuralVillageSmall townSuburbBig city
Would you agree to live with a single parent?

With the motherWith the father
Language Skill
How good is your host country’s language?

FluentUpper intermediateIntermediateElementaryPoorNone
How long have you been studying the language of your host country?
Your native language
Other languages (grade your abilitiy)
Have you ever been abroad before?

yesno
If yes, in wich country?
Have you ever lived on your own?

yesno
If yes, for how long?
Do you wish to attend a language course, when abroad?

yesno
Childcare experience

Children from 0 – 24 months old

Children from 3 – 6 years

Children from 7 – 12 years

Which age groups would you prefer?

0 - 1 year1 - 2 years2 - 3 years3 - 6 years6 - 12 yearsolder
Do you have any experiences with a disabled child?

yesno
Would you take care of a disabled child?

yesno
Describe your experiences in taking care of children
Which duties of housework are you familiar with?

cleanin upironingdoing loundryvacuumingdoing dishescoockingpreparing snakstalking care plantsother
Education and skills
Which graduation/profession do you have?
Current employment situation
Work experiences (also stage)
Your interests (hobbies)?
Do you have additional abilities, like first-aid course, ect?
Do you have a driving licence?

yesno
if no, will you get a driving licence before the arrival date?

yesno
If yes, how often do you drive?
What conditions do you have experience to drive in?

cityruralsnownightrigh hand driveleft hand drive

further information

	yes	no
Would you be prepared to drive the host family’s car?
Do you play a musical instrument?
Are you able to swim?
Do you drink alcohol?
Do you like animals?
Would you take care of pets?
Do you have special diet, allergies ect?

	yes	no
Do you have any dietary restrictions?
Are you vegetarian?
If yes, would you be prepared to cook meat?
Do you smoke?

if you smoke,

	yes	no
Would you smoke outside?
Would you stop smoking, if the family wants you to?

Your family
Mother (name, surname, profession)
Father (name, surname, profession)
Brothers/Sisters (name, age)
Final information
Why did you choose the au pair program? (Please, rate your reasons for waiting to be an au pair)
Have you ever been to the host country before?

yesno
Do you have any contact person in this country?

yesno
If yes, please fill your contact person's details

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Your questions, wishes, suggestions
How did you get to know our agency?
Please upload a photo of yourself smiling

Upload a File

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Please upload some private pictures (with children, friends, family)

Upload a File

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Click to edit

Upload a File

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Click to edit

Upload a File

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A welcome letter “Dear host family” in which you describe yourself, your family, your relationships with children, your hobbies and your motivations as an au pair (at least one page)

Upload a File

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I agree that my e-mail address may be given to other au pair applicants.

yes
All documents should be in the language of the host country or should be translated.
I filed out these documents

on my own
with the support by
place
Date

MonthDayYear
I declare that all of the data given is correct and true.

yes
Signature

Clear
Should be Empty:

Application form for an Aupair placement