Au Pair Registration Form

Feel free to complete this form to register to become an Au Pair.
All personal information supplied will be kept strictly confidential.
Only information in the "Some Details For The Family To Know" section of this form
will be displayed to prospective families.

*Items marked with a hash (#) must be completed.

Your Details
Full Name	#
Address
Street	#
Suburb	#
Post Code	#
E-Mail Address
Home Phone Number
Work Phone Number
Mobile Phone Number
Fax Number
Some Details For The Family To Know
What country do you currently live in?	#
DOB	/ /
Nationality	#
What languages do you speak?
Do you hold a drivers license?
Do you hold a First Aid Certificate?
Do you smoke?
When would you like to commence work?	#
How long is your intended stay?	#
Do you have any hobbies or special interests?
Is there anything else you would like the family to know? Ie. child care experience, special requirements, etc.