Au-Pair Berlin - Application Australia & New Zealand

Please note, that by filling out the form you do not yet have any obligations towards our company!
your contact details (* = mandatory field)
* family name:
* first(given)name:
select destination:
gender: female: male:
date of birth:
residential address
* telephone number:
mobile/cell telephone number
* e-mail:
nationality:
country of birth:
your travel details
do you have a current valid passport?: yes: no:
which country do you plan to visit?:
have you applied for a visa?: yes: no:
type of visa applied for:
working holiday: student:
temporary resident: tourist:
permanent resident:
when can you start?:
how long can you stay?:
employment history / childcare experience
please describe your experience caring for children, and any formal Childcare Qualifications
what were their ages?
please give details about the number of children you would like to take care of and the preferred ages of the children:
childrenīs ages:
0-2 2-5 5-10 older than 10
number of children preferred:
1 2 3 4 more than 4
what is your most recent occupation?:
please detail your employment history
do you have written references?: yes: no:
what are your hobbies and interests?
skills / qualifications / education
what is your ability to speak english?: poor: good: fluent:
please list other languages
spoken
are you planning to study whilst visiting your country of choice?: yes: no:
if yes, at which college(s)?:
course/subject(s):
how many hours study per week?:
please list study timetable
Driving
can you drive a car?: yes: no:
are you able to drive a manual transmission?: yes: no:
are you able to drive an
automatic transmission?:		 yes: no:
do you hold a valid driving licence?: yes: no:
do you hold a valid international driving licence?: yes: i intend to apply:
no: i do not intend to apply:
have you had any accidents?: yes: no:
if "yes", list the date of all accidents, describe what happened, and details of any disqualification
where do you want to live?:
large town:
suburb:
small town / village:
countryside:
no preference:
personal information
what is your religion? please describe any religious needs
do you have any illnesses or allergies?: yes: no:
if yes, please provide details
are you taking any medication?: yes: no:
if yes, please provide details
do you have a special diet?: yes: no:
if yes, please provide details
do you smoke?: yes: no:
do you drink alcohol?: yes: no:
can you cook?: yes: no:
will you cook for children?: yes: no:
will you cook meat for children?: yes: no:
will you do light housework?: yes: no:
are you willing to live with pets? yes: no:
please indicate if you have any of the following:
multiple earrings: yes: no:
nose stud: yes: no:
nose ring: yes: no:
tongue stud: yes: no:
eyebrow stud: yes: no:
visible tattoo: yes: no:
dreadlocks: yes: no:
application
preferred position with host
family:
Au Pair live-in: Nanny live-in:
Nanny live-out: Housekeeper:
preferred contact method:
telephone: e-mail:
do you consent to your
application profile and photograph being forwarded to prospective host families?:		 yes: no:
confirmation
full name:
this information is true and correct:
date of application:

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