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Application form - Au-Pair Australia and New Zealand

Please note:

• Submitting this form does not create any obligation whatsoever towards our agency.
• Please provide all your information in English.

about you:

last name(s): *
first name: *
zip/postal code:
phone: *
mobile/cell phone:
e-mail: *

place of birth:

date of birth: (

travel details:

where do you want to go? *
do you have a current, valid passport?
have you applied for a visa?
if yes, which type of visa?
when can you start? *
how long can you stay? *

host family & surroundings

preferred position with host family:
children’s ages:
number of children:
can you cook?
will you cook for children?
will you cook meat for children?
will you do light housework?

employment history

please describe your experience in child care and list your formal child care qualifications, if any:
how old were the children you cared for?
what is your most recent occupation?
detail your employment history:
do you have written references?
what are your hobbies and interests?

language skills

how good is your english?
what other languages do you speak?
are you planning to attend language classes?


do you hold a valid driving licence?
do you hold a valid international driving licence?
are you able to drive a manual transmission?
are you able to drive an automatic transmission?
have you had any accidents?
if yes, list the date of all accidents, describe what happened, and give details of any disqualification:

personal information

what is your religion? please describe any religious needs:
do you suffer from any illnesses or allergies?
if yes, please elaborate:
do you use any medication regularly?
if yes, please elaborate:
do you follow any special diet?
if yes, please elaborate:
do you smoke?
do you drink alcohol?
please indicate if you have any of the following: multiple earrings
nose stud
nose ring
tongue stud
eyebrow stud
visible tattoo


preferred contact method:
do you consent to your application profile and photograph being forwarded to prospective host families?