Have you been an Au Pair before?            
(If yes, please tell us when, where, for how long and ages of children)

Do you have any childcare experience?
(Please describe giving type of care, ages of children, etc)

What is your main reason for becoming an Au Pair? (Please use as many words as possible)

Are there any activities you enjoy that would be applicable to the children (Ex. biking, swimming, drawing, painting, cooking, etc?)

Are you taking any medication? (If yes, please give details)

Do you have any allergies? (If yes, please give details)

Do you have any dietary requirements? (If yes, please specify)

Do you have any tattoos or piercing? (If yes, please give details)

Do you practice any sports? (If yes, please give details)

How would you describe your character?

Do you have a Criminal Record? (If yes, please give details)

References:

1st Reference

2nd Reference

Name:

Address:

Telephone (Mobile):

How many children:

Age of children:

How long did you work for the family?: