Register as an Au Pair

Register as an Au Pair

First Name
Marital Status
Do you live with your parents? YesNo
Date and Place of Birth
Do you have a steady partner? YesNo
Do you have any children? YesNo
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? YesNo
Can you sew? YesNo
Can you swim? YesNo
Can you drive? YesNo
Licence Date
Would you object to a family of a different religion? YesNo
Would you object to a single parent family? YesNo
Would you object to an ethnic family? YesNo
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? YesNo
Would you describe yourself as: CheerfulReliableCaringFlexibleQuietTalkativeSensitiveGood Sense of HumourOutgoingSportyPunctual
Do you smoke? YesNo
If you smoke, would you agree not to smoke in the house? YesNo
What are your interests/hobbies?
Which sports do you like?
Do you like animals? YesNo
Are you allergic to animals?
Do you have any criminal convictions? YesNo
If yes, please state
Do you possess a Police Clearance Certificate? YesNo
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

If you would like a printed copy of this form, please click here