Au Pair Application Form

IMPORTANT: Please fill all fields.
The more specific you are with your details the more likely we are to find you quickly a suitable family.

 Personal Information: 
First name:
Last name:
Date of birth:
- -
Your weight (kg):
Your height (cm):
Nationality:
Religion:
Your education:
Year of Graduation:
Your current occupation, employment:
Your native language:
Your language skills:
Language 1:
Language 2:
Language 3:
Language 4:
Marital status:
Number of children:
Do you have brothers/sisters? yes no, if yes, what age?
Are you living with your parents? yes no
Mother's name & occupation
Father's name & occupation
 Address: 
Country:
 Post Code:
 City:
Address:
Phone (with country and area code):
Cell Phone (with country code only):
Fax (with country and area code):
E-mail (check carefully):
Information according to your application will be sent to this address
 IMPORTANT: 
Person to contact in case of emergency
Full Name:
 Phone (with country and area code):
 Information concerning destination: 
What country do you want to go?
Have you been to the desired country before? yes no
Do you have any acquaintances or friends in the country you want to go? yes no
For how long would you be able to stay in the host family? month
When are you willing to start? - -
What kind of place do you prefer?     Big City     Small Town     Village     Farm-house
(Please, indicate as many as desired)
Do you wish to attend language classes in the host country? yes no

 Child Care Experience: 
Are you experienced in childcare? yes no
Could you look after babies? yes no
What age-group of children would you prefer?     0-1     1-5     5-10     10-12     Up 12
(Please, indicate as many as desired)
Would you take care of disabled children? yes no
How many children are you able to take care in your host family?
Have you worked as Au Pair before? yes no If yes, where and how long time?
Did you ever assist anyone in Childcare? yes no
If yes, please indicate Childcare Experience

(baby-sitting, daycare, kindergarten, nanny, tutoring, day nursery)
Do you have any references from those families? yes no

 General Information: 
Do you have first aid qualifications? yes no
Do you have criminal record? yes no
Do you have drivers license? yes no. Your driving activity years
Are you allergic over for something? yes no. If yes, please specify
Do you suffer of any diseases? yes no. If yes, please specify
Are you able to send us your medical certificate? yes no
Do you smoke? yes no
Are you a vegetarian? yes no
Are you able to...? Swim Bike
Are you able to ride horses? yes no
What are your hobbies and interests?
Do you play any musical instruments? yes no. If yes, what kind?
Do you do sports? Describe, please:
Do you have experience in house work?
Shopping
Ironing
Cooking
Baking
Dish washing
Sewing
 		Laundering
Cleaning house
Vacuum cleaning
Cleaning childrens room
Tidying rooms
Would you accept a single mother? yes no
Would you accept a single father? yes no
Would you accept a family with another religion or race than your own? yes no
Would you accept a host family with domestic animals? yes no
Would you be willing to take care of pets? yes no
What is your reason for applying?
Any other information:
You can submit up to three photos, preferable with you and children
(Each photo must be not larger than 300KB. Only these extensions are allowed: jpg,jpe,jpeg,gif,bmp,png):

  Personal information collected on this site will only be used by Int. Recruiting Agency NIKA and will not be sold, rented or leased to third parties.

Please click only once and wait for the confirmation page, as it may take a minute to complete the process.