Au Pair Application Form

Personal Information

Surname:

First names:

Address:

Telephone number:

Mobile number:

E-mail:

Skype:

Nationality:

Religion:

Height:

Weight:

Age:

Date of birth:

Parents’ address:

Parents’ telephone number:

Mother's occupation:

Father's occupation:

Do you have any brothers or sisters? How old are they?

General Questions

When do you wish to start?

Planned length of stay in UK:

Where do you wish to work?

Do you have a criminal record?

Are you in good health?

Do you have any allergies?

Do you have any special dietary needs?

Do you smoke?

How many a day?

Would you agree not to smoke in the family’s home? Yes No

Will you accept a family of any race / religion or ethnic origin?

Do you have any experience of children aged: 0-2 3-5 6-9 10+

State any childcare experience you have, incl. ages of children and references:

Do you have a driving licence?

When did you pass?

Would you drive in England?

Can you swim?

Which duties are you prepared to do?
Cook
Iron
Help with shopping
Wash up
Supervise homework
Tidy/dust
Laundry
Babysit
Vaccum
Supervise bedtime

Education & Qualifications

Education:

English level: Basic Fair Good

How long have you studied English?

Do you intend to study English whilst staying here?

Other languages spoken:

Current occupation:

Do you have any First Aid or other certificates? (lifesaving, music etc.)

Hobbies & Interests

Tell us something about your hobbies and interests:

Which sports do you play?

Do you play a musical instrument?

Do you like animals?

Do you have any pets?

What qualities do you find most important in yourself when looking after children? (reliable, flexible etc.)

I declare that all the details given by me on this application form are correct.