Host Family 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 Au Pair.

 Father: 
Name:
 Age:
Occupation:
Nationality:
Religion:
 Mother: 
Name:
 Age:
Occupation:
Nationality:
Religion:
 Address: 
Country:
 Zip Code:
 City:
 Address:
Phone:
 Fax:
 E-mail (check carefully):
 Information about Your Family: 
What kind of place do you live in?
You live in (house, flat, etc.) and number of rooms is .
How long time does it take to reach the nearest city/town? minutes.
Will Au Pair have her own room? yes no
Describe Au Pair's accommodation:
Number of family members live in the house
Number of children, Au Pair is going to take care of
Is Au Pair going to take care of disabled children? yes no
More information about children - name, age, does he/she attend school:
Hobbies and special interests of family:
Family travels often: yes no, if yes would you expect from Au Pair to travel with you? yes no
Do you have animals yes no, if yes what kind of animals?
Should Au Pair take care of pets too? yes no
 Information concerning Au Pair: 
Did you have an Au Pair before yes no, if yes from what country?
The maximum period you had an Au Pair month.
How many days a week you expect your Au Pair to work?
Duties expected from Au Pair:
Shopping
Ironing
Cooking
Dish washing
Laundering
 		Sewing
Getting children up and dress them
Drive them to school by car / walk
Help them with homework
Baby sittings
If there are any other duties that you may require from Au Pair, please specify:
Housework expected from Au Pair:
Cleaning house
Vacuum cleaning
Cleaning childrens room
Tidying rooms
If there are any other offers, please specify:
Do you have a cleaner or any other help in the home? yes no
We will pay Au Pair (DKK) per month
Who will pay for transfer in Denmark? (from/to airport, railway station)
Are you smokers? yes no
Do you allow Au Pair to smoke? yes no outside only
What other foreign languages except English would you prefer Au Pair to speak?
Languages spoken at your home
Will you pay for language course? yes no, if yes what language(s)
Does Au Pair need driver's license? yes no
Will Au Pair have access to the car? yes no
We prefer Au Pair from (country)
We need an Au Pair for the period of month
Expected start date for Au Pair - -
Preferable age of Au Pair years old
Special requests to the Agency:
You can submit up to three photos of your family
(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 be only 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.