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Au Pair Application Form
Please complete all sections
Please select your first choice
 Au Pair Au Pair +
When do you want to start:
How long do you want to stay:
Full Name:
Home Address:
Date of Birth:
Telephone inc International Code:
Mobile Telephone No:
e-mail address:
Nationality:
Passport Number:
Gender:
Height:
Weight:
Religion
Current Occupation:
Father's Occupation:
Mother's Occupation:
Do you have any brothers or sisters:
Yes No
if yes, give details:
Have you ever worked as an au pair before:
 Yes No
If yes, give details:
Have you passed a driving test:
 Yes No
if yes, give date passed:
How often do you drive:
Are you willing to drive in the UK:
Yes No
Do you like animals:
 Yes No
Do you have any pets:
Do you smoke :
 Yes No
Are you willing to not smoke in family home:
 Yes No
How many years have you studied English:
What is your level of English:
Do you wish to attend language classes:
 Yes No

Have you studied any other languages:
 Yes No
If yes, Please give details:
Please give details of your education/studies:
Please give details of your child care experience:
What do you like to do in your spare time:
Are you willing to help the family with household chores:
 Yes No
If yes, give details:
What age of child do you wish to work with:

Note: Although we try to place you with children of the age you prefer,
we cannot always guarantee this
Are you willing to live with a family with no children:
 Yes No
Are you willing to live with a single parent family:
 Yes No
Note: single fathers must provide two references to the agency
 
Would you like to work extra hours for extra money:
 Yes No
Where would you prefer to live:
Note: If you arrive in the summer you must be prepared to live anywhere
Do you have any friends who would like to become Au Pairs:

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

IF YOU ARE NOT SURE OF AN ANSWER TO A REQUIRED QUESTION. PLEASE ENTER 'Don't know'


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.

TELEPHONE: +44(0)20 8905 4400/3355

A-One Au Pairs & Nannies