Form to apply to be an Au Pair
Surname Christian Name  
Gender    Marital Status    Nationality
Religion Age     Do you live with your parents?   
Date & Place of Birth Do you have a steady partner?    Do you have any children? 
Fathers' Occupation  Mothers' Occupation   
Ages of Brothers (if any) Ages of Sisters (if any)
Present Occupation   When can you leave    

How long for?        Where would you like to go? (Country/Region) 

Have you any friends or relatives in the country you
 propose to visit?		 Any Area you would
 prefer to work in
Most positions include light housework.  Is there any
 work you would refuse to do?		 Can you cook? 
Can you sew?   
Can you swim?  
Do you drive?                             Licence Date  
Would you object to a family of a different religion?  Would you object to a single parent family?
Would you object to an Ethnic family? Do you have any allergies? 
Physical Disabilities?        Special diet       Do you have any health problems?
What is your height? Weight
Hair colour    Eye colour  
Do you have any childcare experience? Do you have any childcare qualifications?
Have you any First Aid qualifications? Which languages do you speak (State Level)
Age of children preferred  Do you wish to attend language classes? 
Would you describe yourself as: Cheerful       Reliable          Caring   
Flexible        Quiet   Talkative    Sensitive  Good sense of humour          Out going 

Sporty     Punctual     Do you smoke?    Would you agree to not smoke in the house?

What are your interests and hobbies? Which sports do you like ?
Do you like animals?     Are you allergic to animals?         
Do you have any criminal convictions? 

Do you possess a Police Clearance Certificate ?
If yes, please state
Passport Number        Expiry date
Home Address including postcode
 Email Address                  
Telephone No Daytime      
Telephone No. Evening      
Next of Kin Name & Address including postcode
Telephone No.
Declaration: I declare that the information I have given is true to the best of
my knowledge.  I accept liability for any problem or difficulty that I may
experience as a result of any false information.

Signed      Date   

Please note: The £(current rate) must be sent on application to be on our list.

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