Au Pair in England Web Site - Au Pair Application Form

Au-Pair in England AU PAIR APPLICATION FORM
* Required fields

* Name & Surname

* Sex	Female Male

* Date of Birth You must be between 17 and 27.

* E-Mail address

Phone

Best time to call

* Address in full incl.post code&country

* Nationality We can not accept any other nationalities.

Country of Birth

Father's Nationality & Profession

Mother's Nationality & Profession

Your Sisters' Ages & Professions

Your Brothers' Ages & Professions

What is Your Occupation

How Many Years Have You Studied English?

Please describe your level of English	Little Fair Good Fluent

* What languages do you speak Please give details with levels including your mother tongue

Religion

Do you regularly attend your religious services?	No Yes

* Do you like pets	No Yes

* Do you smoke cigarettes?	No Yes *if yes how many per day:*

If you smoke, do you promise not to smoke at home and around children?	No Yes

* Can you swim?	No Yes

* Are you happy to drive in the UK?	No Yes *if yes how long have you held a license:*

* Do you like children and what experience do you have of children?

* Do you have any special medical requirements or dietary restrictions? If yes, please explain

Are you capable of assisting with the following please check the appropriate boxes	Ironing Washing Vacuuming Dusting Making Beds Helping with the cooking Cooking

Have you been an aupair before, if so when and where?

What are your hobbies?

* For how long do you intend to stay in England?	From: To :

Specify the type of family you would like to be placed with	A Couple with children A single mother A single father

Preferred age group for children

FURTHER REMARKS Please give details if you have any additional requirements or comments in this application form

I HAVE READ AND FULLY UNDERSTOOD EVERY QUESTION IN THE ABOVE APPLICATION FORM AND I HAVE ANSWERED IN FULL AND TRUTHFULLY


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