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

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Your au pair will have to care for children aged

012345678910111213141516171819202122232425262728293031323334353637383940414243444546474849  to 012345678910111213141516171819202122232425262728293031323334353637383940414243444546474849  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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