Au-pair application

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Au-pair application form

Firs name:

Middle name:

Last name:

Gender:

Date of birth:

Nationality:

Address:

Home telephone:

Mobile:

Email address:

Religion:

Ethnic Origin:

What date do you
wish to start?

What is the latest date
that you can start?

How long do you
wish to stay for?

Please give a brief
description of your
education:

What is your level
of spoken English?

	Little	Speaking
	Fair	Understanding
	Good	Reading
	Fluent	Writing

Which other language
do you speak?

Do you wish to attend
English classes?

Yes

Do you have a driving
licence?

Yes

Will you drive in the UK?

Yes

What is you childcare
and Family home
experience:

Would you consider
a family with:

	0 children?
	1-3 children?
	4+ children?

Which age of children
will you care for?

	0-1 years old
	1-3 years old
	4-8 years old
	8+ years old

Would you accept a
single?

	Mother?
	Father?
	Just couple?

Would you accept a
family from different
religion?

Yes

Is there any type of
family you would not
accept?

Do you smoke?

Yes

Do you have any medical
condition that the family
needs to know about?

Yes

If "Yes" what is the
condition?

Do you require regular
medication (As a means
to precaution all au-
pairs/nannies would be
tested before placed
with a family)?

Do you have any
allergies?

Yes

If "Yes" please give
details

Will you go to a family
with cats and dogs?

Yes

Are you prepared to
carry out the
following duties?

Cleaning	Yes	NO
Cooking (for the children)	Yes	NO
Ironing?	Yes	NO
Gardening?	Yes	NO

Can you please describe
your interests, hobbies
and pastimates?

All the information you give us on this form will help us to find the best family for you. Once a family have been identified in accordance with your completed application a sum of £80.00 will be required from you which you need to pay within 10 working days. Can you please send us by post the doctors certificate to say that you are fit and healthy, 2 reference from people that you have worked for/looking after/helping with their children. Please also send us a picture with you and the children you previously cared or for. You should also write a letter introducing yourself and your background for the family.
By clicking the submit button confirms that you have read and understand all the above, you are honest and truthful with your answers and that you accept our terms and conditions.