Type of appliction: *
First name: * Surname:
Male or Female: Mr. Miss
Date of birth: *
E-mail: *
Mobile: *

Skype Address:

Postal Address:


Post Code:




Marital status:


Passport #:

Nearest airport:

Hobbies & interest:

Fluency in English:

* Other languages:

Last school:


Present occupation:

What do your friends and family think about you being an au pair?

Earliest date of arrival:


Length of stay:


Do you have any preferred ages of children you would like to take care of?

Have you ever been an au pair?

* If yes, provide some information:
How did you hear about this program? *
How do you plan to spend your leisure time here in China? *
Describe yourself briefly.(pls include your personality etc.): *
Why do you want to join this program? *
What are your future plans? *
Verification Code: *



Qingdao Au pair Cultural Exchange Co. Ltd.,
Address: Room 806,First Office of Silver Building,
Liaoning Road - Shibei District,
Qingdao City - Shandong Province,China.
Contact: Ellen Peng. Cell phone: 0086-13001690831
Office Phone: 0086-532-85953378 / 85950965