APPLICATION FORM FOR
AU-PAIRS
Family name:
First name:
Date and Place of Birth:
Address:
Telephone number:
Nationality:
Address and Telephone Number of Parents:
Profession of Father / Mother:
Desired length of Stay:
Do you have any special wishes with regard to region/ Country of Placement:
Would you accept a family living in:
Countryside… Small Town… Suburb…
City…
Where do you live in your Home Country:
Countryside… Small Town…. Suburb…. City…
Do you Smoke?
Could you refrain form smoking in the house of the Host Family :
Do you have any Allergies:
Do you have any Dietary Restrictions:
Education and Diplomas:
Have you taken any courses relating to Childcare/ please give details:
Current or latest Occupation:
Native Language:
Command of Language:
English Excellent….. Good….. Average…. Fair….. Poor…..
German Excellent…. Good…. Average…. Fair….. Poor….
French…………..Excellent…. Good…. Average… Fair…. Poor….
Other Languages :
Do you want to take Language Lessons during your stay:
Previous Stays in other Countries:
Do you have a Driving Licence:
Would you be willing to drive for your Host Family:
What kind of experience do you have with children ( Specify: playing,
help with homework, babycare, leisure time activities, ect. ):
With Children of what age to you have experience:
With what age groups do you have experience:
Babies 0-1yr…. Toddlers 1-3yr…… Pupils 4-6yrs….. 6-10yrs…… 10yrs.+……
What experience of domestic work do you have:
What are your hobbies:
Can you swim: Do you like animals:
Would you care for pets:
Would you accept to work additional hours for more pocket money:
Have you ever been in conflict with the police:
I Certify that information I have given in the Application Form is true
and complete. I agree to perform my duties as an au-pair to the best of
my ability.
Date
Signature