First Name
Last Name
Email Address
Nationality
Languages Spoken
Sex	female male
Marital Status
Address: Street
City
State
Postcode
Country
Contact Phone Number
Best time to reach you
Au Pair/ Nanny Position Information
Are you seeking:	Full Time Live In Live Out Position
Can you commit to at least 3 month?	Yes No
Will you study in Australia?	Yes No
Where?
What hours?
What months?
Do you have a visa to come to Australia?	Yes No
If yes what type?	Permanent Resident Holiday Study Working holiday Other
Visa Number
Are you open to a position outside the Sydney region?	Yes No
Date available to begin work
How long will you stay in Australia?
How long will you work?
Date of birth
Height
Weight
Health	excellent good fair poor select one
Do you smoke	Yes No
If yes, how much?
Do you take any prescription medication on a regular basis?	Yes No
If yes, which ones?
Any allergies?	Yes No
If yes, what are you allergic to?
Can you drive?	Yes No
Automatic vehicle	Yes No
Manual geared vehicle	Yes No
Describe any accidents that may appear on your drivers licence record.
Level of English (1 is fluent)	1 2 3 4 5
Do you have a police record	Yes No
Duties:	Please select yes, no or maybe to the duties you would be willing to undertake.
Childcare for working parents	yes no maybe select one
Childcare for stay at home parents	yes no maybe select one
Childcare for single parents	yes no maybe select one
Cooking for children	yes no maybe select one
Housekeeping related to child's care	yes no maybe select one
Cooking for family	yes no maybe select one
Housekeeping for family	yes no maybe select one
Do you like cleaning	yes no maybe select one
Do you like cooking	yes no maybe select one
Do you like house pets	yes no maybe select one
Please describe your childcare experience giving dates, duties and age of children cared for.
Any other comments you think would be helpful to us
What improvements would you like us to make to our site.