About you

Surname / last name *

First name *

Your email address *

Your address

Address / street / building *

Postcode (ZIP code) *

City *

State / province / region

Phone number *

Fax number

URL of your private home page

Where do you live

You live ...

in a big city
in a small town
in the country

In which country are you living

U.S.A. AlbaniaAlgeriaAndorraAngolaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBelarusBelgiumBoliviaBosnia and HerzegovinaBotswanaBrazilBulgariaCameroonCanadaChileChinaColombiaCongoCosta RicaCôte d'IvoireCroatiaCyprusCzech RepublicDenmarkEcuadorEgyptEstoniaFinlandFranceGeorgiaGermanyGhanaGreeceHungaryIcelandIndiaIndonesiaIrelandIsraelItalyJapanKenyaKyrgyzstanLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMalaysiaMexicoMoldovaMoroccoNamibiaNetherlandsNew ZealandNigeriaNorwayother countryPeruPhilippinesPolandPortugalRomaniaRussiaSingaporeSlovakiaSloveniaSouth AfricaSouth KoreaSpainSwedenSwitzerlandThailandTurkeyUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVenezuelaYugoslaviaZambia

Your nationality

American AlbanianAlgerianAndorrianAngolanArgentinianArmenianAustralianAustrianAzerbaijanianBahamianBelarusianBelgianBolivianBosnian HerzegovinianBotswanianBrazilianBritishBulgarianCameroonianCanadianChileanChineseColombianCongolianCosta RicanCroatianCyprianCzechDanishDutchEcuadorianEgyptianEstonianFilipinoFinnishFrenchGeorgianGermanGhanaianGreekHungarianIcelandicIndianIndonesianIrishIsraeliItalianIvoirianJapaneseKenyanKoreanKyrgyzLatvianLiechtensteinianLithuanianLuxembourgishMacedonianMalayanMexicanMoldovanMoroccanNamibianNew ZealanderNigerianNorwegianother nationalityPeruvianPolishPortugueseRomanianRussianSingaporeanSlovakSlovenianSouth AfricanSpanishSwedishSwissThaiTurkishUkrainianUnited Arab EmiratesUruguaianUzbekVenezuelanYugoslavianZambian

About your family

How many children will the au pair have to look after

0123456789

Your au pair will have to care for children aged

012345678910111213141516171819  to 012345678910111213141516171819  years

Have you had an au pair before

Yes   No  

Are you a single parent

Yes   No  

Will the au pair have to care for disabled children

Yes   No  

Do you smoke

Yes   No  

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