Application Form For Au Pair
Please fill ALL fields


I would like to work as Au Pair in


Address ( country, city, zip code, street, ect. )

Phone / Fax

E-mail (double check!)


Civil life

Do you have brothers / sisters, if yes what age

Do you have any experience with children, if yes what age were they at that time

Do you have a driving licence, if yes from what time

Do you have criminal record

Do you smoke

When you can start your work


Basic school (1-9)

what year

Basic school (1-3)

what year


what year

Other education

what year

Profession (have you worked before)

if yes, where 

Have you worked as Au Pair before, if yes where and how long time


Do you have any references from those families or others which know you well

from :

Are you allergic against something

if yes what : 

What child diseases have you had

specify which 

Have you any serious sickness lately

if yes what :

Which languages do you speak

I would be interested in language course to better my :

Tell us about your hobbies

How many children are you able to take care off in you hostfamily

number of children what ages

Are you able to send us your medical sertificate if family require that

Can you swim


Are you vegetarian


Do you like pets


have you worked with handicap children


Dou you accept a single parent


Are you registered in some other agency now


Additional comments ( if any )