Familj ansökan

General information

First name of mother

Last name of mother

First name of father

Last name of father

Date of birth of mother

Date of birth of father

Nationality/Citizenship of mother

Nationality/Citizenship of father

Occupation of mother

Occupation of father

Do you have children?

YesNo

If yes, provide their names and ages

Do any of your children have a handicap or disability?

YesNo

Marital status

contact information

Phone:

Fax:

Phone at work:

Cell phone:

Address:

City and Province

Zip code:

Country:

Email:

Family environment

House

Location

Which public transportation is available near your home?

What is the spoken language at home?

Which other languages are you willing to speak?

Do you have any pets? If yes, specify which and how many.

Do any of the members of your family smoke?

List your family hobbies

Au Pair

Au Pair needs to speak

Other language skills required:

Select if relevant

When do you want the Au Pair to start?

Tasks for the Au Pair

Free time for Au Pair

Monthly fee for Au Pair

We are prepared to pay the ticket of the Au Pair (or share the cost)

YesNo

We would prefer an au-pair who is:
years old

Will your au-pair be able to attend a language class at your expense?
YesNo

Will your au-pair need a driving licence and the ability to drive a car?

YesNo

Will your au-pair have access to a car?

YesNo

We would prefer to have an au-pair from

Additional comments