All information is confidential and will not be shared with anyone other than Planet Au Pair and host families. Please print,  fill out every section (please use black ink) and fax the documents and email the photos; send them all by regular mail or scan everything (including the signed application) and email everything (preferred).

Target county: ___________________________ (For Spain, click here)

Name_____________________________________________________________________
           Family                                          First                                  Middle

Address: Street ______________________________________________________________

City ___________________________ State/Province ___________________

Country __________________________ Postal Code ________________

Telephone ________________________ Best time to call ___________________  

FAX_____________________ Email:___________________________ 

NIF or Passport Number _____________________ Country ___________

Date of Birth___________  Religion_______________  Nationality________________

Height______  Weight______  Sex___  Occupation____________________

When do you wish to be placed?__________________ (Not guaranteed)

For how long? 3 mos. ___ (only in summer) 9 mos.____12 mos.____ longer__________.

Please note that families prefer that you stay until the end of May for long term stays, regardless of when you arrive.

Previous occupation (s):_______________________________________________________

_________________________________________________________________________

Name, address and phone number of next of kin in case of emergency:

_______________________________________________________________________

________________________________________________________________________

Father's occupation___________________ Mother's occupation__________________

Brothers and sisters and their ages: _____________________________________________

When did you leave school?______________ Qualifications___________________________

What are your career plans?___________________________________________________

Target country's language proficiency level:  Excellent ____ Good____ Fair____ Poor____ None___

Do you speak any other languages and at what level?__________________________

Do want to attend language classes?___________________

What is your experience with children and their ages:__________________________

______________________________________________________________________

______________________________________________________________________
 

What are your interests, hobbies and child care related activities you can/would undertake ?

______________________________________________________________________

______________________________________________________________________

Are you an animal lover?_______________ Do you have a full driver's license?_____
Have you ever been away from home and,  if so, why, when and for how long?

______________________________________________________________________

______________________________________________________________________

Do you understand that you will be expected to help with the child care related light housework?______

Do you smoke?_____ If you smoke, would you be willing to smoke only outside of your host's home?_____

Do you understand that if you smoke against your host's wishes, they are completely within their rights to ask you to leave?_____

Do you have any health problems?_____  Allergies?_____  Criminal record?_____

What ages of children do you prefer?___________  Do you like babies?______

How many children are you willing to look after?_______________

Do you wish to be placed near friends or relatives? If so, please give details____________

_____________________________________________________________________

I, the undersigned, confirm that all the information provided above is true. I further understand that the minimum contract of service is for a period no shorter than the time specified on this application form.

Signed_________________________________ Date__________________

How did you hear about us?______________________________________________

Why do you want to be an au pair?

In consideration of you, Planet Au Pair, accepting me for your Au Pair in Europe program,

I HEREBY AGREE:

1. to abide by all appropriate regulations and laws of my target country.
2. to carry out my duties as an au pair to the best of my ability.
3. to pay my way, to and from my home country and my target country.
4. to stay as long as I have indicated on my application.

I hereby warrant that all information I have given in the application is accurate and complete. I agree to perform my duties as an au pair to the best of my ability and indemnify Planet Au Pair and their staff against any loss or damage suffered by any of them or any claims made against them as a result of any breach or negligence by me during my participation in the programs. Any claims will be directed to the collaborating agency or host family in my target country. I agree that a non-refundable placement fee of 319 € will be paid upon acceptance by Planet Au Pair. 

It is agreed that Spanish law shall apply to this agreement and I agree to submit to the jurisdiction of the Spanish courts.
 

Full Name____________________________________ Signed______________________________________ Date_______________________

Additional Comments: