partnerzy
Au Pair English version - Register on-line
Do you require: F         M
Au Pair summer 2 - 4 months         Au Pair up to 24 months
Au Pair couple
Start Date:
Length of stay:
First Name:
Family Name:
Full Address:
City:
Postcode:
Country:
Home Phone:
Mobile Phone number:
E-mail:
Father's Occupation:
Father's Nationality:
Mother's Occupation:
Mother's Nationality:
Marital status:
Has anyone in your family ever been charges with a criminal offence or a prosecution pending?:
YES        NO
Please give name, age and sex of child:
Do you have any disabled children: YES         NO
Family Hobbies:
Religion:
Languages Spoken:
Preferred age of au pair:
Would you prefer a smoker or non smoker? Smoker         Non smoker         Any
Do you require a driver? YES         NO
Would you provide a car for au pair? YES         NO
Do you require a swimmer? YES         NO
Would you accept an Au Pair who did not speak very good English? YES         NO
Would you accept a vegetarian Au Pair? YES         NO
Do you have any domestic help? YES         NO
ABOUT YOUR HOME:
Do you have any pets:
                           Please state the distance from your home to the nearest:
Bus/Train Station:
English School:
Shops:
Nearest Airport:
How many bedrooms do you have?
           Please describe the au pair's accommodation:
           Describe au pair's duties:
Average working hours per day?
Average working hours per week?
Number of evenings babysitting a week?
Au Pair pocket money:
Will your Au Pair be able to attend a language course?
Have you had an Au Pair before YES         NO
if yes, how many and what nationality?
           “Dear Au Pair” letter (this letter should introduce your family, hobbies, home, etc.)
          Name and tel. number of a personal referee (eg. last au pair)   
I/We declare that the above information is true and correct and any untrue statements may stop all placements.
I/We have read the terms and conditions of the agency and agree to adhere to them.

Hereby I agree to process my personal data due to recruitment process according to Personal Data Protection Law from 29th August, 1997, Dziennik Ustaw no.133, item 833.
I have read the Terms and Conditions: