Name

Address

Home Telephone

Mobile

Work Telephone

E-mail Address

Skype Address

Messenger ID

Nationality

Date of Birth

Mother’s Occupation

Height and Weight

Number and ages of siblings

What is your religion?

Do you practice your religion?

Languages spoken and studied

What are you doing at the moment (working / studying)

Please briefly describe your previous employment

Please describe any relevant experience for being an Au Pair

If yes, state when and reasons for leaving

Would the new family be able to speak to the old family as a reference?

Have you been to University?

What type of Au Pair placement are you willing to do?

When would you like to start? (month or specific date)

How long would you like the Au Pair placement to be?

What is your preferred age range of the children?

Can you drive and would be prepared to drive in the UK?

Would you take a single parent?

If so, mother, father or either?

Would you take a family with no children?

What is your level of English? required

What is your ideal location (e.g. Any place, specific location, village or town)?

Are you in good physical and mental health?

Do you have a criminal record or driving convictions?

Are you a smoker?

Do you prefer more childcare or more housekeeping?

How much housework are you prepared to do?

Please outline any type of housework duties you would not do [This may affect how quickly we can place you]

Are you prepared to do babysitting during weekdays (up to 2 a week)?

How much pocket money are you expecting per week?

Please specify any other skills you have which would be relevant for being an Au Pair?

I have completed this form honestly and truthfully?

Please enter the letters in the box

Father’s Occupation

Have you been an Au Pair before?

Are you prepared to smoke outside or sign a non smoking declaration?

Are you happy with pets? State any you are not happy with

Have you ever done a first aid course?

Can you swim?

Describe your personality?

What are your key strengths which make you an ideal candidate for being an Au Pair?

Are you a vegetarian?

Please specify any allergies or special diet requirementsYou have, if any?