Name:

Email:

Gender:

Nationality:

Street Address:

Suburb / City:

Country:

Postcode (ZIP code):

Phone number:

Fax number:

Have you worked as an au pair before/ housekeeper or nanny?

Have you had experience with house work or minding children

Do you have a driver's license?

Do you smoke?

How old are you?

You speak these languages fluently:

You have basic knowledge of:

Which program are you interested in? (You can choose more than one)

Which package are you interested in?

In which country are you currently living?

Do you have a particular area that you wish to live in?

Do you have a passport?

Do you have a Working Holiday visa for Australia?

Do you have a Student Visa for Australia?

Do you have the date for your arrival?

When you would like to start your accommodation?

Would you like to stay longer than 3 months?

How did you hear about Au Pair House Accommodation?

Additional Comments Please mention any special requirement you may have for your family, so we can try to match perfectly with one of our families.

I accept that some of the information provided may be passed to the prospective family and will be on file in our database only for our au pair business. It will not be used for any other purpose.

Au Pair Accommodation Registration