*Your Name

*Sex Female Male

Address

*Home Telephone

*Mobile Phone

Work Telephone

*Email Address

Skype

Messenger ID

*Nationality Austrian Belgium Czech Dutch French German Hungarian Italian Polish Romanian Spanish Swedish Other

Other Nationality
(Please specify)

*Date of Birth

What is your religion? Christian Muslim Sikh Jewish Buddist Not religious

Do you practice your religion? No Yes

Your Height

Your Weight

Mother's Occupation

Father's Occupation

Do you have any brothers/sisters? No Yes

Number and ages of siblings

Languages spoken and studied

What are you doing currently?
(e.g. working, studying)

Previous employment
(e.g. part and full time employment)

*Any Childcare experience Alot of experience Some experience None

What childcare experience do you have?
Please detail age group of children you have looked after

*Have you been an Au Pair before? No Yes

If previously an Au Pair
Please state when, and reasons for leaving

Can we contact your previous family? No Yes

Have you been to University? No Yes

*Can you drive No Yes

*Your level of English Basic Good Fluent

*Do you have a criminal record? No Yes

*Start date
(Day/Month/Year)

*Type of Au Pair Au Pair (up to 25 hours) Au Pair Plus (up to 35 hours) Mother's Help (up to 45 hours)

*Length of placement 3 - 6 months 6 - 12 months up to 2 years

*Preferred age range of the children Don't mind any 1-3 4-6 7-10

*Minimum pocket money you will accept? £70-80 £81-90 £91-100 £101-110 £111-120 £121+

Would you take a single parent? Yes No

Who would you prefer? Mother Father Either

Would you take a family with no children? Yes No

What is your preferred location? Any/don't mind Village Semi rural Rural Suburbs Small Town Urban Centre

Are you in good physical/mental health? Yes No

Are you a smoker Yes No

Will you sign a non smoking declaration? Yes No

Are you happy with pets? Yes No

Do you prefer childcare or housekeeping Prefer childcare Don't mind either Prefer housekeeping duties

How much housework will you do? Light (1 hour a day) Medium (up to 2 hours a day) Heavy (3 hours a day or more) Don't mind

Any housework you won't do?
(Note: this may affect how quickly we can place you)

Will you do babysitting? Yes No

What other skills do you have?
(e.g. which would make you a good Au Pair)

Have you done a First Aid course? No Yes

Can you swim? Yes No

Are you a vegetarian? No Yes

Can you cook? Can't cook - prefer not to Can't cook - but happy to learn Basic cook Love to cook

Do you have any special diet needs or allergies? None Wheat Gluton Lactose Other

What food allergies
(e.g. other specific allergies)

Describe your personality?

What are your key strengths which would make you a good candidate?

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