Au-Pair - Registration Form

To become a au-pair we need some information from you. Please fill all questions truely.

We also need some references, pictures and a medical certificate. Please send us this infromation by post or by email.

We are looking to your registration.

First Name:
Gender:     female     male
Earliest beginn of your au-pair activity:
Length of stay:     6 month     12 month
Nationality: Religion:
Date of birth: place of birth:
Size: Weight:

Education / Profession?

actual employment?

your hobbies?
Name of Father:
Name of Mother:
Count of silbings:
Age of Silbings
Do you have some experiences with children?

Are you able to care for handicapped children?     Yes     No
Do you have experiences with babies?     Yes     No
Would you like to live in a single parent family?
Mother   Vater   No
Which experiences do you have in housework?

Can you cook?

    Yes     No
If yes, what would you like to cook?

Do you like pets?     Yes     No
Do you smoke?     Yes     No
Would you turn done smoking at the hostfamily?     Yes     No
Can you swim?     Yes     No
Do you have a driving licence?     Yes     No
Are you vegetarian?     Yes     No
Do you play a musical instrument?     Yes     No
If yes which musical instrument?
Do you have any allergy?     Yes     No
If yes, which allergy do you have?
Which residential area do you perfer? City countrified   whatever
(Please keep in mind, a placment in a countrified region could be faster)

How are your English-skills?
  very good   good   satisfactory   pass   poorly unlearned

Where and how long do you learned English?
Do you speak other languages?
Did you visit other countries? If yes, where and how long?

Your Interests? Your Conceivabilities? Why do you what to go abroad?

You assure that all information the TRUTH, when you send this form!

Büro: +49 (0)5321 - 78 64 00
Fax:   +49 (0)321 - 21 20 67 44

Copyright © Au-pair Agentur "Alice", 2005