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Au-pair

Family

Au-Pair Registration

1. About you

Surname

Name

Street, house number

Postal code, city/town

Country

Nationality

Number of your foreign passport

Valid till

1^st phone number

2^st phone number

Fax

E-mail

ICQ number

Gender:

	Male
	Female

Date of birth (day/month/year)

Height

Weight

Family status:

	single
	married
	divorced

Do you have children?

	yes
	no

Confession

Education

Profession

How did you know about our web site?

2. About your family in more detail

Mothers name

Mothers profession

Fathers name

Fathers profession

Brothers and sisters (number, age)

3. About taking part in an Au-pair program in detail

In what country/countries do you want to spent a year as an au-pair ?

The earliest date of arrival (month/year)

In Germany now	after recieving visa

The latest date of arrival (month/year)

Desired duration of stay (6-12 months)

months

Desired age of children

0-3 years

	preferably
	possible
	in the last resort

4-11 years

	preferably
	possible
	in the last resort

12-18 years

	preferably
	possible
	in the last resort

Where would you like to live?

City/town

	preferably
	possible
	in the last resort

Small city/town

	preferably
	possible
	in the last resort

Countryside

	preferably
	possible
	in the last resort

4. What family is acceptable for you?

A family with 2 children

	yes
	no

A family with 3 children

	yes
	no

A family with more than 3 children

	yes
	no

Single mother

	yes
	no

Single father

	yes
	no

A family with a mentally deceased child

	yes
	no

A family with a physically ill child

	yes
	no

Do you have an experience in looking after ill children?

	yes
	no

Will you look after pets?

	yes
	no

5. Foreign language skills

German

	freely
	good
	little
	no

English

	freely
	good
	little
	no

French

	freely
	good
	little
	no

Other languages

6. Experience in communication with children and housekeeping

Experience of working with babies

	good
	sufficient
	little
	no

Experience of playing with children

	good
	sufficient
	little
	no

Experience in looking after children

	good
	sufficient
	little
	no

Experience in cooking

	good
	sufficient
	little
	no

Will you bake?

	good
	sufficiently
	little
	no

Will you tidy up?

	good
	sufficiently
	little
	no/span>

Will you launder, press?

	good
	sufficiently
	little
	no/span>

Will you go shopping?

	good
	sufficiently
	little
	no

7. Driving license

Do you have a driving license?

	yes
	no

If yes, then how long have you had it? (Months/years)

Do you have experience n driving?

	yes
	no

8. Hobbies

Can you swim?

	yes
	no

Can you ride a bicycle?

	yes
	no

Can you play any musical instruments?

	yes
	no

Other hobbies and interest

How can you characterize yourself?

9. Subsidiary points

Do you smoke?

	yes
	no

If yes, then could you not smoke in the house?

	yes
	no

Do you have allergies?

	yes
	no

Other deceases?

Have you been to Germany as an au-pair before?

	yes
	no

Have you filled in forms in other agencies?

	yes
	no

What about other countries?

	yes
	no

A letter to a future family (about yourself, your interests, reasons, why you to want to visit Germany as an au-pair)

Dear Family,

Write number

Photos (3 is the upper limit, in .jpg format)

I claim all the information about me to be true and I would inform the Innova Consut of every change. I have received the following instructions 'Au-pairs' living in German families' and 'Information about au-pairs living in German families', I've read them and understood all the content carefully. I agree the brief data about me to be placed on Innova Consult site and on purpose of mediation be processed and handed over to interested families.

Yes No