Personal details

Surname _____________________________________________

Christian Name (s) _____________________________________

Address ____________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Town ___________________________ Post Code _____________________

Country ______________________

Telephone number (plus area code) _______________________ Fax no (plus area code) ______________________

Email ______________________________ Nationality ___________________________

Height _______________________ (in cm) Weight ______________________________

Age __________ Date and place of birth _____________________________

Passport / Identity Number ________________________________________

Underline your choice:

Do you wish to be an: Au Pair / Mother's Help / Nanny

In which country do you wish to be placed:

UK England / Wales / Scotland / Ireland

Europe France / Germany / Italy / Spain / Greece / Austria / Finland / Switzerland / Belgium / Turkey / Other ________________

AuPairCare Programme (USA): Yes / No (Brochures and application will be sent to you by post)

N.B. If you wish to apply for details of the AuPairCare programme please complete
the AuPairCare Pre-Application Form.

When do you wish to commence employment? ________________________________________________________

Length of employment (USA - 1 year stay only) _______________________________________________________

Do you require a live in or live out position____________________________________________________________
(Nannies / Mother's Help, UK positions only)

Salary / Pocket Money required ___________________________________________________________________

Please specify destination of your choice:

1st Choice ____________________

2nd Choice ____________________

3rd Choice ____________________

Do you prefer town or countryside? ________________________________

Education / Employment details

Last School / College / University attended ___________________________________________________________

Examinations / Qualifications obtained _______________________________________________________________

____________________________________________________________________________________________

English level (Not applicable to British Nationals) Basic / Fair / Good

How long have you studied English? ________________________________________________________________

Other languages spoken ______________________________________________________ Basic / Fair / Good

_________________________________________________________________________ Basic / Fair / Good

_________________________________________________________________________ Basic / Fair / Good

Current occupation _____________________________

Length of notice to be given __________________________

Previous occupation ________________________________________________________________________

Do you have any First Aid or other certificates? e.g. Lifesaving, Certificates of Merit, Swimming, Music, Sports etc.

__________________________________________________________________________

Do you have any formal childcare qualifications? Yes / No

If yes, which qualifications do you have?

_________________________________________________________________________________

Experience with child care and housework

Childcare: State ages of children you have cared for and please submit references:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Housework _________________________________________________________________________________________
_________________________________________________________________________________________

Cooking __________________________________________________________________________________
_________________________________________________________________________________________

Additional information

Are you in good health? ____________________________

Do you have any allergies __________________________________________________

Do you have a criminal record? ________________________________________________________________

Do you eat everything? __________________________________

Will you accept a family of any religion / race or ethnic origin? ____________________________

Do you smoke? _________ How many a day? _________

Would you agree not to smoke in the family's home? ____________________

Which sports do you play? _______________________________________________________________________

Do you like animals? ___________________________________

Do you have a driving licence? _________________________

Date test passed ______________________________

Would you drive abroad? __________________________________________

Give details concerning your hobbies and interests and any further information which will enable us to find a suitable placement for you:

_________________________________________________________________________________________

_________________________________________________________________________________________

____________________________________________________________________________

Declaration

I fully understand the Agency's conditions and accept that the fee payable (for placements in Europe excluding UK) is only a finders fee. I agree to abide by these conditions. furthermore, all the details given by me on this application form are correct.

Name _____________________________ Signature __________________________

Date _________________________

1. 6 smiling passport photographs with your name on reverse.
2. At least 2 large photographs showing you with children / babies.
3. A medical certificate stating you are fit to work with children.
4. An autobiographical letter written in the language of the country where you wish to be placed.
5. At least 2 child-care references from teachers / employers etc.
6. All these items must accompany your completed application form.
7. If you have requested a Nanny placement, copy of NNEB or similar certificates, should accompany your application form.

E-mail:aupairs1@btconnect.com