Application form for Au-pairs

The Au-Pair Agency

231 Hale Lane Edgware London HA8 9QF

Tel: +44 (0) 20 8958 1750 Fax: +44 (0) 20 8958 5261

elaine@aupairagency.com

The application form is available as an on-line form below. It is very important that all questions are answered.

Surname:
First Names:
Address:
Address2:
City:
Post Code:
Country: (if your country is not on the list, you cannot be registered as an au-pair)	Andorra Austria Belgium Bosnia Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Faroe Islands Finland France Germany Greece Greenland Hungary Iceland Ireland Italy Latvia Liechtenstein Lithuania Luxembourg Macedonia Malta Monaco Netherlands Norway Poland Portugal Romania San Marino Slovak Republic Slovenia Sweden Switzerland Turkey United Kingdom
Telephone:
Mobile:
Fax Number:
E-mail Address:
Personal details
Date and Place of Birth:
Sex:	Male Female
Nationality:
Religion:
Marital Status:	Single Married Separated Divorced Widowed
Father's Occupation:
Mother's Occupation:
Number of brothers & ages:
Number of sisters & ages:
Employment sought
The agency only accepts au-pairs who can stay for at least nine months.
I'd like to be:	Au Pair Yes No Au Pair Plus (EU applicants only) Yes No
Starting date:
Minimum length of stay (in months):
Maximum length of stay:
I prefer to be in:	A town Countryside No preference
I prefer this region:
Education & experience
Education and Diplomas:
Present occupation:
Knowledge of English:	Poor Moderate Fluent
Number of years spoken:
Other languages spoken:
What experience do you have with children?:
Date of leaving school
Date of leaving college / university
Occupation/s since leaving full time education. Please give dates and details of all jobs
Preferences
I am ready to help with children aged:	0-1 years Yes No 1-12 years  Yes No 13+ years Yes No
I am ready to stay with a family with:	Adults only Yes No A single mother Yes No A single father Yes No Of a different religion  Yes No
I am wiling to help with a physically disabled child:	Yes No
I am willing to help with a mentally disabled child:	Yes No
I will accept a family with a cat:	Yes No
I will accept a family with a dog:	Yes No
More details
Are you allergic to anything? Please state:
Are you under medical treatment? Please state:
Are you vegetarian?	Yes No
Are you prepared to cook fish & meat?	Yes No
Will you accept a family who is vegetarian?	Yes No
Are there any foods you never eat?
Do you smoke?	Yes No
If yes, how many cigarettes a day ?
Will you promise not to smoke in the presence of the family, their children, inside the house or the garden?	Yes No
Do you have a driving licence?	Yes No
Date driving licence obtained:
Are prepared to drive in the UK?	Yes No
What are your hobbies?
Name, address and phone number to contact in case of emergency:
Do you have friends currently working in the UK?	Yes No
If so, where are they?
How did you find our site?
If someone else referred you, who are they?
Please give the names of all other au-pair agencies contacted:
Why did you choose The Au-Pair Agency?

Declaration
Have your parents given you permission to apply for a post as an au-pair?		Yes No
I confirm that I have answered all of the above questions truthfully.		Yes No
Note: You will be sent further details by post. You will be asked to sign a document confirming that you agree to the terms and conditions of the agency.Your parents will be asked to confirm in writing that they will buy an open return ticket before you travel or that you will bring sufficient funds to the UK so that you can return home immediately if necessary.Please note that the Au-Pair Agency will not lend any money to an au-pair at any time, irrespective of the emergency.
Do you wish to make any other comments?Do have any other questions?