Au Pair Agency Cefelin - Application Form

Please note that submitting this form does not create any obligation whatsoever towards our agency!

About you:
Salutation:
Last name: *
First name: *
Nationality:
Passport number:
Passport valid until:
Birthday: (DD.MM.YYYY)
Place of birth:
Country of birth:
Religion:
What is your highest completed education?
Contact information:
Phone no.: *
Mobile phone:
E-mail: *
Alternative phone no.:
When can we best reach you by phone?
Your registration address:
Street:
Postal code:
City:
Country:
Your current address (leave blank if equal to registration address):
Resident with (c/o):
Street:
Postal code:
City:
Country:
Closest relative
(e.g. parent, for use in case of emergencies)
Last name:
First name:
Street:
Postal Code:
City:
Country:
Phone:
Your family:
Your father’s occupation:
Your mother’s occupation:
How many siblings (brothers and sisters) do you have?
How old are your siblings?
Language skills
German:
Where and when did you learn German?
English:
Where and when did you learn English?
What other languages do you speak?
Are you planning to attend language classes in Germany?
Your stay in Germany
Which programme are you applying for?
When would you like to start? *
How long would you like to stay? *
In what kind of environment would you like to live?
Urban
Small town
Countryside
How many children would you like to care for?
How old would you like the children in your care to be?
Why do you want to come to Germany as an Au-Pair?
Health information
Are you allergic to something?
If yes, please specify:
Do you suffer from any illnesses?
If yes, please specify:
Do you have any special eating habits (e.g. vegetarian)?
If yes, please specify:
Domestic experience: Are you used to the following kinds of work?
Ironing:
Cooking:
Cleaning/Vacuuming:
Other domestic work:
Other skills and experience:
What is your previous child care experience?
Do you have a driving licence?
Can you drive a bicycle?
Can you swim?
Do you like pets?
Do you smoke?
If yes, would it be a problem for you to not smoke inside?
What are your hobbies and interests?
Your application:
Are you also applying to other au-pair agencies?
Note: If you find a host family through another au-pair agency, please inform us immediately!
If yes, which one(s)?
Please note that submitting this form does not create any obligation whatsoever towards our agency!
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