Your FIRST Name:
Your LAST Name (family/surname):
Address:
Town/City:
Postcode:
Country:
Tel:
Fax:
E-mail:
YOU MUST SUPPLY AN EMAIL ADDRESS! NB: check the address is correct - it is easy to make a typing error!
Country you want to au pair in:	GERMANY  - If it's not Germany, you're using the WRONG form!!
Sex:	Female Male
Date of birth:
Nationality:
Marital Status:	Single Married Divorced
Religion:
Your Profession:
Profession of your father:
Profession of your mother:
Your level of education:
Do you have any sisters?	No Yes - If yes, what ages?
Do you have any brothers?	No Yes - If yes, what ages?

Date you would like to start working:
Length of stay:
Level of German:	FluentGoodAveragePoor
List any other languages you speak?
What child care experience have you had and with what ages?
What age range would you like to au-pair for?
Where would you prefer to stay?	Town Country Village By the sea Anywhere
If there is a particular town / area you want to go to, please list. (eg: Munich, Berlin etc.)
Would you accept a one parent family?	No Yes, if single mother Yes, if single father
Do you have a driving licence?	No Yes - If yes, are you prepared to drive in Germany? Yes No
What household duties are you used to?	Ironing Vacuuming Washing-up Cooking
Can you swim?	Yes No
Do you like pets / animals?	Yes No
Are you a vegetarian?	No Yes - If yes, would you be able to prepare meals containing meat? Yes No
Do you smoke?	No Yes
If yes, can you restrict this to smoking outside the house and when you’re not with the children? Yes No
Do you have any allergies?	No Yes - If yes, please list:
Do you have any other medical conditions?	No Yes - If yes, please list:
What are your hobbies?
What do you intend to do after your au-pair job has finished?
Other comments:

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