au pair agency – registration form for au pairs

Info for Families

Au pair application form:

Are you applying as an au pair couple?:

Please enter your email address, this will be your user login when you want to access your acount.
Please choose a password of at least four characters long and enter it here, this will be your user password when you access your account.

* Email: *Confirm Email:

* Password: *Confirm Password:

* First Name: * Address:

* Surname: * Town/City:

* Mobile: * Country:

* Home Telephone:     Post Code:

   Are you in the UK already?: * Nationality:

* DOB (dd/mm/yyyy): / / * Gender:

* Would you like to receive email alerts when a new family registers?:

   What is your religion?:

   Fathers profession:

   Mothers profession:

   Current Occupation:

How long have you been learning English?:

What is your standard of English?:

   Do you speak any other languages?:

* What date are you available to start? (dd/mm/yyyy): / /

* How long would you like to stay for?:

Where would you like to Au Pair?:

Do you have any childcare experience?
Please give as much detail as possible:

Please write a letter to families explaning why you want to be an au pair.

   Please give as much information as you can:

* What type of au pair would you like to be?:

Aupair:               Aupair Plus:

Aupair Couple:   Mothers Help:

Please give details of any health problems or disabilities:

* Do you smoke?:

   Can you swim?:

   Do you like pets?
   Please give details of the animals you like:

* What do you do in your spare time?:

* Can you drive?:

* For how long have you been driving?:

Please state which types of families you would accept living with.:

Single Father:

Single Mother:

Different Religion:

Disabled Person:

Elderly Person:

Without Children:

   What ages of children would you prefer to look after?:

Please give any other information you think may be useful,
or any requests that you may have:

   Please provide details of 2 referees. If you have childcare experience
   Please give the name of your employer for one reference.
   Give the name, address, telephone number, fax number and email address of your referees.
   They should not be family members:

* Referee1 Name: Referee1 Email:

* Referee1 Tel: Referee1 Fax:

* Referee1 Address:

* Your Relationship to the referee:

Referee2 Name: Referee2 Email:

Referee2 Tel: Referee2 Fax:

Referee2 Address:

Your Relationship to the referee:

AGENCY/PROMOTION CODE:

Declaration of Truth - I confirm that I have read and understood all of the above, and that to the best of my knowledge I have answered all questions fully and honestly.

I have read and agree the scale of charges and terms and conditions of business.
Terms and Conditions