E-Mail address:*

Password (minimum 6 characters):*

Destination

HILFE

Destination Country?*

Contact Information

HILFE

Last name:*

First name:*

Street, house number:*

ZIP Code:*

City:*

Home Country:*

Phone (incl. country code):*

Phone 2 (incl. country code):

Mobile number (incl. country code):

Skype:

Personal Data

HILFE

Birthdate (dd.mm.yyyy):*

Place of birth:*

Nationality:*

Religion:*

Gender:*

Passport valid until (dd.mm.yyyy):

General Information

HILFE

Education, apprenticeship, studies, etc.:*

Profession:

Current job:

Have you been Aupair before?*

If yes: where/how long?

Do you have relatives/contact persons in the destination country (name, address, phone)?:

Do you have a driving license?*
Where did you get it?
Would you drive a car in the destination country?

If yes: how long is your driving experience?

Do you play any musical instruments?*

If yes: which?

Can you swimm?*

Can you ride a bike?*

Do you smoke?*

If yes, would you abstain from smoking inside the house?*

Would you accept a family which smokes?*

Do you have any health constraints, allergies, diseases?*

If yes: which?*

Are you previously convicted?*

Are you vegetarian?*

If yes: would you prepare dishes with meat although?*

Do you like pets?*

Would you also care for the pets of the family?*

Your hobbies and interests:*

Regarding your Au-pair stay

HILFE

Preferred duration of stay as an Au-pair:*
(usually 6-12 months)

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

Latest possible start date (dd.mm.yyyy):*

Where would you accept the domicil of the family to be?
(multiple choice possible)

Preferred age range of the children:*

Up to how many children would you
prefer to take care of?*

How many children would you take care at most?*

Do you have experience in child caring?*

	Good	Sufficient	Little	None
Baby care:
Dress children, put them to bed:
Engage children, play with them:
Supervising homework:

Briefly describe your experiences with children:*

Would you accept a single father/mother?*

Would you be ready to care for a handycapped child?*

Do you have experience in caring for
a handycapped child?*

Do you have experience in domestic chores?*

	Good	Sufficient	Little	None
Cooking:
Preparing small dishes:
Baking:
Doing laundry:
Ironing:
Cleaning up:
Hoovering:
Other experiences:

Why did you decide to take part in the Au-pair program?*

Special wishes, comments
(preferred town of the host family, meal, pets, etc.):

Your language knowledge

HILFE

Knowledge in the English language:*

Knowledge in the language of the Destination Country:*

How long did you learn this language?*

Where did you learn this language?

Would you like to attend language courses?*

Your mother tongue is:*

Other languages you know (with levels):

About your Family (optional)

HILFE

Your brothers and sisters
(how many, age):

Mother:
(First name, family name, profession, contact details)

Father:
(First name, family name, profession, contact details)

Letter for the unknown Host Family

HILFE

Please write a nice letter to your future host family:*
About yourself, your hobbies, your experience with children, your motivation, future plans, ...

(Dear host family,...)

Your can write the letter later and send it by Email to us,
or as a scanned version or through snail mail.

Other Information

HILFE

Did you apply also at other agencies?*

I filled in the form...*

Do you accept your contact data to be forwarded to other Au-pairs, allowing them to get into contact with you (for friendship)?*

How did you hear about us?*
E.g.: Google, Internet ad, friends, other Au-pair,
adverticement, black board,...

Message for the Aupair For Kids Team

HILFE

Here you can leave a message for us,
if you have questions, comments and so on:

Confirmation

HILFE

Herewith I confirm and agree to the following terms:

Please confirm:* Yes No

Safety Code:*