Please select your 1st choice: AU PAIR AU PAIR +

Please select your 2nd choice: AU PAIR AU PAIR +

When do you want to start?

How long do you want to stay for?

Name:

Date of birth:

Nationality:

Religion:

Address:

Telephone number:

Mobile number:

Email address:

Occupation:

Height:

Weight:

Passport number:

Do you like animals: Yes No

Do you have any pets?

Do you smoke: Yes No

Are you willing NOT to smoke in the host family's home: Yes No

Do you hold a driving licence? Yes No

How long have you held your licence?

Do you drive regularly? Yes No

Are you willing to drive in Britain? Yes No

How many years have you studied English?

What is your level of english: Very Good Good Intermediate Poor

Do you wish to attend a language course? Yes No

Have you studied any other languages? if so, what and for how long?


Please give us some details of your studies?

Please give us some details of your childcare experience?

Do you have any criminal convictions? Yes No

Do you have any medical conditions that my affect you during you stay?


Have you had any medical treatment in the past three years? Yes No

Are you willing to help the family with houseland tasks?
Please state what you are willing to do.

What age of child do you want to work with?
(Although we try to place you with children of the
age you require we cannot always gaurantee this)

Are willing to live with a family with no children? Yes No

Are you willing to live with a single parent family?
(single fathers provide two references to agency) Yes No

Would you like to work extra hours for extra money? Yes No

Would you like to live in the countryside, town, by the sea etc
.(If you arrive in the summer you must be prepared to live anywhere)

What do you do in your free time?

Do you have any friends wishing to be Au Pairs in England?

Please give any details which you feel relevent to
help agency make the correct placement:

IMPORTANT: DO NOT BOOK A TRAVEL TICKET UNTIL YOU RECEIVE AN INVITATION
LETTER FROM THE HOST FAMILY AND THE AGENCY. THE AGENCY CANNOT BE HELD RESPONSIBLE FOR THE TICKETS BOOKED.

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