application form

To apply to be an Au pair in Ireland with the Douglas Au pair Agency, YOU MUST be a citizen of the European Union or a country that does not require a visa to enter Ireland, aged between 18 and 26 years. You must be in good health both mentally and physically and most importantly you must have a genuine interest in children. Please DO NOT apply if you do not meet this criteria, as we will not be able to process your application. An Online application does not guarantee a placement as we require you to send us additional documents to support your application, these documents are listed at "Please Read This".

our service to the Au Pair is FREE, FREI, GRATIS

ALL SECTIONS OF THIS FORM MUST BE COMPLETED

Requested length of stay (in months)		Sex	Female	Male
Name		Age
Address		City
Country		Date of Birth
Nationality		Religion
Fathers occupation		Mothers occupation
Phone (with country and area codes)		Mobile phone
Height		Weight
E-mail address
Start date	As soon as posible	Or

Are you in good health?	Yes No	Are you taking any medication? Yes No
Have you any allergies?	Yes No	If Yes to either of these questions please give details:
Have you had any serious illness lately?	Yes No	If Yes to either of these questions please give details:
Any disabilities?	Yes No	If Yes to either of these questions please give details:
Do you have any brothers or sisters?	Yes No	If Yes, how many and what are their ages: ............ ............

Do you have a driving license?	Yes No	Since...
Do you have a criminal record?	Yes No	If yes ,would you if required, refrain from smoking in the family home? Yes No
Do you smoke?	Yes No

Can you swim?	Yes No	Would you consider a placement with a single father? ............ Yes No
Are you a vegetarian?	Yes No	Do you have a steady boyfriend? ............................ Yes No
Do you like pets?	Yes No

Tell us something about your personality which might be useful for your host family:

Tell us about your hobbies

What are your future plans?

Do you have any formal training or experience with children or worked with kids before? . Yes No
If Yes: How old were the children; when and where?		...........
Can you care for a baby:	Yes No	Can you cook basic meals? Yes No
Have you any knowledge of First Aid?	Yes No

Education
Hight School	Yes	What years? to
College	Yes	What years? to
Other education	Yes

What languages do you speak besides your own
Your level of English, Fair/Good/Fluent?
Do you wish to attend a language school?

Work experience (name the last two positions)
	What years? to
	What years? to

Have you worked as an Au-Pair before? When & where.	Yes No
Can you give references from those families?	Yes No
If Yes, please name them with phone numbers:

	Phone .........
	Phone .........

What age group of children do you prefer to work with: for example Newborn, 9- 24mths, 2-5years, 5-10years, All age groups: What is the maximum number of children that you are willing to work with (please be flexible):

Location in order of Preference for example, City Suburb/Town,Country, Coastal Village :

The best time to reach me is
Are you registered with any other agency now	Yes No
If yes, which agency are you registered with:
In case of an emergency whom can we contact:	(phone)
	(phone)

When you have filled in the form, please click the "Submit Query" button only ONE TIME! Double clicking or repeated clicks on this button may disturb transmission. The form will reach our office in Cork, Ireland, in less than a minute!

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