Register as an Au Pair

Register as an Au Pair

First Name
Marital Status
Do you live with your parents?  Yes No
Date and Place of Birth
Do you have a steady partner?  Yes No
Do you have any children?  Yes No
Father's Occupation
Mother's Occupation
Age of brothers (if any)
Age of sisters (if any)
Present Occupation
When can you leave?
How long for?
Where would you like to go (country/region)?
Have you any friends or relatives in the country you propose to visit?
Any area you would prefer to work in?
Most positions include light housework. Is there any work you would refuse to do?
Can you cook?  Yes No
Can you sew?  Yes No
Can you swim?  Yes No
Can you drive?  Yes No
Licence Date
Would you object to a family of a different religion?  Yes No
Would you object to a single parent family?  Yes No
Would you object to an ethnic family?  Yes No
Please give details of any health problems or physical disabilities
Please give details of any allergies
Do you require a special diet? If so, please give details.
What is your height?
Hair Colour?
Eye Colour?
Do you have any childcare experience?
Do you have any childcare qualifications?
Do you have any first-aid qualifications?
Which languages do you speak (State Level)?
Age of children preferred
Do you wish to attend language classes?  Yes No
Would you describe yourself as:  Cheerful Reliable Caring Flexible Quiet Talkative Sensitive Good Sense of Humour Outgoing Sporty Punctual
Do you smoke?  Yes No
If you smoke, would you agree not to smoke in the house?  Yes No
What are your interests/hobbies?
Which sports do you like?
Do you like animals?  Yes No
Are you allergic to animals?
Do you have any criminal convictions?  Yes No
If yes, please state
Do you possess a Police Clearance Certificate?  Yes No
Passport Number
Expiry Date
Home Address (including postcode)
Skype ID
Daytime telephone number
Evening telephone number
Mobile telephone number
Next of Kin's Address (including postcode)

Agreement to Agency Terms

Declaration: I declare that the information I have given is true to the best of my knowledge. I accept liability for any problem or difficulty that I may experience as a result of any false information.

I Accept:  Accept
Full name
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