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 send them all by regular mail or scan everything (including the signed application) and email everything (preferred).
Target country: (For Spain, click here)
Family First Middle
City State/Province _
Country Postal Code
Telephone Best time to call
Mobile/Cell Email: Skype ID
NIF or Passport Number Country
Date of Birth Religion Nationality
Height Weight Sex Occupation
When do you wish to be placed? (Not guaranteed) End date
For how long? 3 mos. 6 mos. 9 mos.12 mos. longer .
Au Pair (six hours a day, five
days a week)
Au Pair Plus (eight hours a day, five days a week) ___
Old folks caregiver (only in England)___ Au Pair Couple (only in England) ___
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 FairPoorNone
Do you speak any other languages and at what level?
Do want to attend language classes? Yes No
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? Yes
Do you have a full driver's license? Yes
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? Yes No
Do you smoke? Yes No If you smoke, would you be willing to smoke only outside of your host's home? Yes No
Do you understand that if you smoke against your host's wishes, they are completely within their rights to ask you to leave? Yes No
Do you have any health problems? Yes No Allergies? Yes No Criminal record? Yes No
What ages of children do you prefer? Do you like babies? Yes No
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.
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 to pay the placement fee once I've accepted a family and the family has accepted me. There is a €50 late fee for payments later than seven days after receiving the invoice.
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