Au-Pair Berlin - Anmeldeformular

Please note, that by filling out the form you do not yet have any obligations towards our company!

your contact details (* = mandatory field)

applicants data:
* gender male | female
* surname
* first name
Select Destination
* when can you start?
* how long can you stay?
date of birth: (DD.MM.YYYY)
Nationality:
place of birth:
city:
country:
current address:
street:
postcode:
city:
country:
* tel. no:
mobile phone:
* e-mail:
nearest relative:
surname:
first name:
street:
city:
country:
father's occupation:
mother's occupation:
ages brothers & sisters:1:
2:
3:
4:
5:
religion:
education, including examinations passed:
work experience - please give
dates:
present job & dates:
what languages do you speak? what level?
language 1:
level: basic | 2 | 3 | 4 | native
language 2:
level: basic | 2 | 3 | 4 | native
language 3:
level: basic | 2 | 3 | 4 | native
do you wish to attend language classes? yes | no
give a brief summary of your experience, indicating the nature of care provided, the ages of children and for how long:
childcare experience and training:
please give details about the number of children you would like to take care of and the preferred ages of the children:
children's ages: 0-2 | 2-5 | 5-10 | older
number of children preferred: 1 | 2 | 3 | 4 | more
domestic experience:
washing up:
do you have experience? yes | no
are you willing to do? yes | no
ironing:
do you have experience? yes | no
are you willing to do? yes | no
cooking:
do you have experience? yes | no
are you willing to do? yes | no
vacuuming:
do you have experience? yes | no
are you willing to do? yes | no
dusting:
do you have experience? yes | no
are you willing to do? yes | no
laundry:
do you have experience? yes | no
are you willing to do? yes | no
driving:
do you have a driving licence? yes | no
when did you pass your test?
are you willing to drive abroad? yes | no
do you drive regularly? yes | no
details of any accidents:
do you have any first aid training?
if yes, which?
activities:
can you swim? yes | no
can you play a musical instrument? yes | no
what are your interests?
sports, hobbies, music etc.
why do you want to be an au pair?
what are your future plans when
your au-pair stay is ended?
where do you want to live?:
large town suburb
small town countryside
village no preference
Would you accept a single parent family?
mother only: yes | no
father only: yes | no
would you work with a disabled
child?		 yes | no
do you have any experience? yes | no
which experiences do you have
with a disabled child?
have you been abroad
without your family?		 yes | no
if yes (please give details)
have you ever been convicted
of a criminal offence?		 yes | no
health declaration:
are you undergoing any treatment/check up due to injury, handicap or physical disorder? yes | no
if yes (please give details)
do you suffer from any allergies? yes | no
if yes (please give details)
do you use any medication
regularly?		 yes | no
if yes (please give details)
do you suffer from any kind
of eating disorder?		 yes | no
if yes (please give details)
do you follow any special diet? yes | no
if yes (please give details)
do you smoke? yes | no
if yes, how many per day?
will you promise not to smoke in
the house or in front of the children?		 yes | no

please ensure you have read and understood the information provided by the agency for au pair applicants and agree to follow the guidelines.

yes | no