Questionario Au Pair

Fill out the form below to submit your Au Pair request and we will get back to you as soon as possible.

Country where you would like to experience as au pairs

Program type

Earliest start date

Latest start date

Length of stay (Months)

Name

Surname

Email

Mobile Phone

Gender

Date of birth

Place of birth

Nationality

Living Address

Address

Number

City

State/Province/Region

Postal Code

Country

Do you smoke?

Yes

No

Could you refrain from smoking in the family home?

Yes

No

Driver?

Yes

No

Would you drive for the family?

Yes

No

Religion

Weight

Have you had any health problems in the past?

Any allergies/intolerances/special diet?

Are you vegetarian/vegan?

Yes

No

Would you prepare meat meals for the family?

Yes

No

Any problem with the law?

Studies performed

Present occupation

Future plans

Any other talent/skills which may be useful

Can you swim?

Yes

No

Do you like pets?

Yes

No

Previous experience in childcare?

Yes

No

Describe all your childcare experience in as much detail as possible

Would you be willing to work additional hours for more pay?

Yes

No

Do you have experience with disabled children?

Yes

No

How many children do you wish to care for?

Are you willing to work with a single mother/father?

Yes

No

Have you been an au pair before?

Yes

No

Are you willing to help your host family?

Which are your reasons to become an au pair?

Your experience in domestic work

Which location do you prefer?

Would you like to attend a language course?

Yes

No

Have you ever lived away from home?

Yes

No

What is your native language?

English

French

German

Spanish

Italian

Referent #1

Name

Surname

Referent #1 Address

Referent #1 Phone

Referent #2

Name

Surname

Referent #2 Address

Referent #2 Phone

In case of accident or emergency give the name and address of next of kin

Name

Surname

Emergency Address

Emergency Phone

Letter to the family

Photo

Choose File