Au Pair Application Form for U.K.
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Personal Information
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Please attach a photo of yourself from your hard disk as "jpg"
or "gif", max. 15 Kbyte (smiling!)
Picture too big? Minimise it here
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Name of Agency abroad if applicable:
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Full Name (first name first):
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Nationality:
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Age and Date of Birth:
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Sex:
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female
male
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E.Mail address
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Home telephone number (including country code - area code - number):
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Mobile phone number:
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Fax Number (and state to whose attn?):
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Full Address in home country:
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Passport number and date of expiry:
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Do you have a valid visa to come to the UK as an Au Pair?
If 'yes' when does it expire?
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What religion are you?
Are you practising (how often do you pray)?
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Height and weight:
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Height
Weight
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Do you have any distinguishing marks, tattoos or body piercing?
If 'yes' please describe:
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Your earliest start date:
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Your latest start date:
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How long could you stay if you are happy with the family, or
must you go back to your country by any date (state date and reason)?
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Mother and Fathers first names, ages, occupations:
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Mother:
Father:
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Brothers and Sisters, including names and ages:
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Education and work experience
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What is your level of English (please be honest)?
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Speaking
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Very Good
Good
Average
Basic
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Understanding
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Very Good
Good
Average
Basic
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Reading
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Very Good
Good
Average
Basic
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Writing
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Very Good
Good
Average
Basic
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For how long have you been studying English?
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years
hours per week?
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Do you speak any other languages, and to what level?
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Please state your education level and any qualifications achieved:
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Please describe your work/professional experiences?
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Please describe your childcare experiences,
the ages of the children, the number of children, type of work
(example - in a camp, hospital, school, babysitting, etc):
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Type of Au Pair you want to be
please note that the duties will be a mixture of childcare and
light housework, and that the working hours do not include the
2/3 babysitting nights per week which you will be required to
do.
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Please tell us which type of Au Pair position(s) you would consider:
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Demi (15 hours per week)
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Yes
No
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Regular (25 hours per week)
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Yes
No
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Au Pair Plus (35 hours per week)
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Yes
No
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Mothers Help (full time)
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Yes
No
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Would you accept to live with a family with:
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Children of any age
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Yes
No
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Babies 0-1
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Yes
No
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Toddlers 1-2
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Yes
No
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Children 3-4
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Yes
No
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School age children 5-8
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Yes
No
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School age children 7-12
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Yes
No
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Teenagers 13 +
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Yes
No
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Disabled child
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Yes
No
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Child with learning difficulties
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Yes
No
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Would you accept to live in a family with:
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1-2 children
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Yes
No
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2-3 children
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Yes
No
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don’t mind how many
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Yes
No
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Would you accept a single parent family?
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Mother
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Yes
No
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Father
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Yes
No
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Would you accept an adult only family?
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Yes
No
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Would you accept to live with an elderly person?
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Yes
No
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Would you accept a placement in:
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London and suburbs
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Yes
No
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Any City
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Yes
No
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A large town
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Yes
No
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A small town or village
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Yes
No
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The Countryside
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Yes
No
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The Coast
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Yes
No
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Don’t mind
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Yes
No
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Have you lived away from home before (if ‘yes’ please give details)?
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Please describe your hobbies and interests (if you can draw,
paint, be creative, play musical instrument, sew, play football,
computers, etc):
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Can you swim?
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Yes
No
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Do you have any experience with gardening and/or household maintenance?
If 'yes' please describe:
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Can you drive?
If ‘yes’ please state your level of experience, for how long have
you had your license, and how often you drive?
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Would you be prepared to drive in Britain?
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Yes
No
After practice
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Do you smoke (if ‘yes’ how many do you smoke in one day)?
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Smoking:
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Would you agree not to smoke in the house and around the children?
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Yes
No
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Would you accept a smoking family?
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Yes
No
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Would you accept a non-smoking family?
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Yes
No
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Are you vegetarian, or do you have any special dietary requirements
(if ‘yes’ please describe)?
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If you are a vegetarian, would you consider living with a meat
eating family?
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Yes
No
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If you are not a vegetarian, would you consider living
with a vegetarian family?
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Yes
No
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Please indicate the level of experience you have with the
following tasks(i.e. good experience, some/fair experience,
or no experience):
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Looking after babies birth - 1
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Good
Fair
None
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Looking after children 1-2
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Good
Fair
None
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Looking after children 2-4
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Good
Fair
None
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Looking after children 5-8
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Good
Fair
None
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Looking after children 9+
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Good
Fair
None
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Playing with children
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Good
Fair
None
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Keeping children occupied
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Good
Fair
None
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Taking children out (swimming etc)
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Good
Fair
None
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Getting children up and dressed
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Good
Fair
None
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Putting children to bed
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Good
Fair
None
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Bathing children
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Good
Fair
None
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Household cleaning
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Good
Fair
None
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Cooking
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Good
Fair
None
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Ironing and washing clothing
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Good
Fair
None
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Looking after old people
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Good
Fair
None
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Looking after disabled people
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Good
Fair
None
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Looking after pets
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Good
Fair
None
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Health
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Are you taking any medication
(if ‘yes’ please give details)?
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Do you have any allergies
(if ‘yes’ please give details)?
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Do you suffer from, or have you ever suffered from any long term
ailment, any disabilities, or ever had psychiatric treatment (if
‘yes’ please give details)?
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Have you ever been an Au Pair in Britain?
If ‘yes’ please give name and address of host family, the length
of time you were with them, the amount of children in the family,
the ages of the children, and the reason why you left them.
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Have you ever been convicted of a criminal offence, or been in
any trouble with the police?
If ‘yes’ please give details.
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Please explain why you want to be an Au Pair, and what future
plans you have after your au pair stay:
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Do you have any special requests, which will help us to match
you with the host family?
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How did you hear about Angels International Au Pair Agency?
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References
- Please fill out the following information about your referees,
and fax, e.mail or post to us the written references, along with
your ‘dear family’ letter, medical certificate, and any other
snapshot photos of you with children and/or your family.
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Your childcare reference. Name, address, telephone number, e.mail
and/or fax number (required):
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Your character reference. Name, address, telephone number, e.mail
and/or fax number (required):
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I declare that the information given by me is true. I accept
responsibility for paying my fares to and from England, and for
any language classes and fares to and from the school.
I understand that being an Au Pair means living as a member
of the family and is not an independent life style, and that it
puts limitations on my activities. I agree to abide by any reasonable
rules laid down by the host family. I agree to look after children,
baby-sit required evenings, and that I will perform tasks connected
with/or constituting light housework/housekeeping. I shall be
honest, fair with my host family, and act responsibly, and I shall
endeavour to do as well as I can. I acknowledge that any information
given to me about potential clients of The Agency, or other applicants
is highly confidential and I shall not pass any of this information
to anyone without The Agency consent. I give permission to The
Agency to display my (anonymous) details whilst looking for a
suitable host family for me.
I shall inform Angels International of any change, and that
I must give at least two week’s notice to my host family and/or
The Agency should I want to terminate the engagement. I understand
that I cannot hold Angels International Au Pair Agency responsible
or liable for anything that happens to me during my stay in Great
Britain.
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Your name:
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Signature and Date:
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