Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

Country

(###)

###

####

How would you describe your English level? *

Fluent

Intermediate

Basic

Do you speak any other languages?

Yes

No

What was your highest level of education? *

High School

College

University

Other

Would you be open to reviewing a host family's profile if they have not yet submitted their police checks? *

Yes

No

How many months would you like to work as an Au Pair? *

Tick all that apply

1 - 3 Months

3 - 6 Months

6-12 Months

When would you prefer to start? *

MM

DD

YYYY

Which city would you like to Au Pair in? *

Tick all that apply

Sydney

Melbourne

Brisbane

Gold Coast

Sunshine Coast

Perth

Adelaide

Northern Rivers

Canberra

Darwin

Other

How much childcare experience do you have? *

Tick all that apply

0 - 50 hours

50 - 100 hours

100 - 200 hours

200 - 500 hours

500+ hours

What age group do you most enjoy working with? *

Tick all that apply

< 1 Years (infants)

1 - 2 years old (toddlers)

2 - 5 years old (pre-school)

6 - 9 years old (primary school)

10 - 12 years old (pre-teens)

13+ years old (teenagers)

Comfortable with all age groups

Do you have experience working with children with special needs? *

Yes

No

Other

Are you open to working with children with special needs? *

Yes

No

Please select all relevant courses you have completed:

Tick all that apply (not necessary to be eligible)

Childcare Course

First Aid Course

Are you willing to work with a single parent? *

Yes

No

Have you been an Au Pair before? *

Yes

No

Do you smoke? *

Yes

No

I understand I need to provide a Police Check & Working with Children check *

We can assist you with this

Yes

I have read & understood the terms and conditions on this website *

While every care is taken in introducing families, the agency is not responsible for any problems arising from information that is provided as incorrect and I accept the conditions of this agency. I hereby declare that the information is given on this form and the enclosed documents are true in every respect.

Yes

Date Signed *

MM

DD

YYYY