Surname *

First name *

Address *

Town/City

County/Province

Country

Postcode

Phone

Home * 

Mobile

Email Address *

Please re-enter

Date of birth * 
(dd/mm/yyyy)

What is your sex?

What is your nationality?

Do you have a Visa?

Do you have a Working Holiday visa?

Only applicable to applicants from Australia, Canada and South Africa

Please enter a password. You will need this to login to the site to view your account, check for new families, and change your profile.

password

Please describe why you would like to be an au pair.

Have you had any childcare experience?   Select Yes No

Please describe your experience.

Have you been an au pair before?   Select Yes No

Please give details.

Do you have any allergies?   Select Yes No

Please give details.

Do you have any health problems?   Select Yes No

Please give details.

Do you require a special diet?   Select Yes No

Please give details.

Do you play sports? Please describe fully.

Do you smoke?   Select Yes No

Can you swim?   Select Yes No

Do you like pets? Please describe fully.

Please describe your interests as fully as possible.

What level of English do you speak?   Not spoken Basic Fair Good Fluent

What languages, other than English, do you speak.

Can you drive?   Select Yes No

If you can drive, What is your experience and when did you start driving regularly?

Where would you like to work?
(max. 3 preferences)
ctrl key+click to select

AustraliaAustriaBelgiumCanadaDenmarkHollandFranceGermanyNew ZealandSpain Sweden SwitzerlandUnited KingdomUnited States

When would you like to start? (dd/mm/yyyy) *

How many months would you like to stay?

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Would you accept working for a family with:

 - a single mother?

Select Yes No

 - a single father?

Select Yes No

 - a different ethnic origin?

Select Yes No

 - elderly persons?

Select Yes No

 - no children?

Select Yes No

 - a different religion?

Select Yes No

Are you willing to do light housework?

Select Yes No

Are you capable of looking after:

0-1 years 1-3 years
3-5 years 5-15 years
Disabled children

Please give any special request you may have.