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  (*denotes required field)

  First Name*

  Surname*

  Date Of Birth

  Ages /number of children looked after (if applicable)

  Current Address

  Town

  County

  Post Code

  Mobile Phone

  Daytime Phone

  Evening Phone

  Facebook ID

  Email Address

  Country/Nationality

  Other Languages

  Do you have experience as an Au Pair in the UK?

  What are you presently working as ?

  Level of English:

  Beginner Average Good Very Good

  Have you been an Au pair before?:
  Yes
  No

  Father's Profession

  Mother's Profession

  Details of Brothers and Sisters

  Your Religion

  When do you want to start work In The UK?*

  How long do you want to stay? (please note you will be a lot less likely to get work if you say its for less than 6 months)

  Your Personality:

  • Active
  • Flexible
  • Enthusiastic
  • Adaptable
  • Polite
  • Open Minded
  • Friendly
  • Reliable
  • Punctual
  • Optimistic
  • Responsible
  • Shy

  
  

  Hobbies & Interests:

  • Aerobics
  • Biking
  • Fitness
  • Jogging
  • Football
  • Volleyball
  • Rollerblading
  • Tennis
  • Cooking
  • Painting
  • Reading
  • Skiing
  • Hiking
  • Swimming
  • Horse Riding
  • Dancing
  • Theatre
  • Cinema
  • Sight Seeing
  • Computers

  
  

  Can you organise activities for children?:
  Yes
  No
  Some

  Are you patient with small children?:
  Yes
  No
  Sometimes

  Can you command children's respect?:
  Yes
  No
  Sometimes

  Are you able to assist with these general duties?:

  • Care for Babies
  • Care for Newborn
  • Care for Older Children
  • Babysitting
  • Caring for pets
  • Light Housework
  • Cooking
  • Washing
  • Ironing

  
  

  Are you allergic to anything?

  Do you smoke?:
  Yes
  No
  Sometimes

  Do you like pets?:
  Yes
  No
  Sometimes

  Are you vegetarian?:
  Yes
  No

  What kind of visa do you have? (if any)

  List your top 5 UK locations where you would like to work

  Do you hold a valid driving license?:
  Yes
  No

  Are you comfortable driving in the UK?:
  Yes
  No
  Maybe

  How did you hear of Exclusive Aupair Agency?

  Do you have a special message you would like to pass on to host families?

  Are you already registered with au pair agencies in your country of origin? if so put agency names here

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