Name Host Mother
Date of Birth
Occupation, working hours away from home
Name Host Father
Date of Birth
Occupation, working hours away from home
Do either of you work: nights
weekends
shifts
Address
Phone
Mobile phone
E-mail
Skype name (if available)
Your Children
Please write their names, date of birth, favourite activities, interests, special needs (e.g. medication, allergies, disability)
Child 1
Child 2
Child 3
Child 4
Does any other person live in your family home?
Yes
No
If yes, please list their name, date of birth and relationship to you
Family Information
What language is spoken at home?
Do you speak any other language(s)?
The Au Pair should speak with our children in
Have you employed an Au Pair before?
Family activities and hobbies
Do you have any pets?
Yes
No
If yes, what pets and does the Au Pair need to help look after the pet(s)?
Does your family have any special dietary habits/needs? If yes, please explain
Do you smoke?
Yes
No
Does anyone in your family suffer from medical conditions (physical or emotional)?
Yes
No
If yes, please explain
If you are divorced or separated, do your children spend time with another parent or caregiver as well? If yes, please describe the arrangement
Has either parent, or anyone living in the family home, ever been convicted of a crime?
Yes
No
Your Home
Please describe your family home (e.g. layout and size of your home, garden)
Please describe the Au Pair bedroom (size in m², furniture, TV/Radio available? Own bathroom or shared bathroom?)
Does the Au Pair have access to WIFI Internet?
Yes
No
The family lives in a
rural area
small town
city
suburb
Nearest city is
Is reasonable public transport available to the city?
Yes
No
Where is the nearest language school?
Is public transport available to get to the language school?
Yes
No
Other (please specify)
Au Pair Requirements
When would you like the Au Pair to start?
Latest possible start for the Au Pair?
How long would you like the Au Pair to stay?
Would you like the Au Pair to have any special interest/skills (e.g. sports, music)?
Yes
No
If yes, what interests/skills?
Would you consider a male Au Pair?
Yes
No
Would you consider an Au Pair with special dietary needs (e.g. vegetarian)?
Is the Au Pair allowed to smoke?
Yes
No
Does the Au Pair need a valid driver’s licence?
Yes
No
Does the Au Pair have access to a car for work use?
Yes
No
...for private use during her time off?
Yes
No
Au Pair Job Description
Is the Au Pair sole charge?
Yes
No
If yes, what are the times the Au Pair is in sole charge?
Is the Au Pair a Parent Help?
Yes
No
Mainly working alongside host mother/host father?
Please describe the daily routine of your family (e.g. get-up time, times children are at kindergarten or school, working hours of parents, afternoon activities, meals, bedtime for children etc.)
Please describe the general jobs you expect the Au Pair to do
What usual days and times do you need your Au Pair to work?
When are the Au Pairs’ days off?
Please add anything you may want the Au Pair to know (e.g. wishes and expectations, parenting style, special family situation, family holidays etc.)
These are the reasons why our family would like to host an Au Pair
How did you hear about us?
Please email your family photos to JavaScript must be enabled to view this email address
We confirm that we would like to host an Au Pair from Germany and that the information provided by us is correct. We confirm that we are happy for this information and our photos to be shown to prospective Au Pair applicants.
