The AuPair Shop: Application Form


P.O. Box 147, Radlett, Herts, WD7 8WX TEL: 01923 289 737 (two lines) FAX: 01923 289 739 EMAIL: WWW: www.the-aupair-shop.com
Application Form
Please complete this online form with as many details as possible to enable us to find a suitable placement for you.

Personal details * required
*Surname (Family name):
*Foreame(s):
Street address:
Town/City:
County/State:
Post Code:
Country:
*Telephone number (plus area code):
Mobile or 2nd telephone number (plus area code):
*email address:
Nationality:
Height:
Weight:
Age:
Date of birth:
Place of birth:
Passportor Identity Card Number:

Choice
Do you wish to be an, Au Pair Mother's Help Nanny HouseKeeper
In which country do you wish to be placed?		or or other?
For the USA program,
go to for the form, go to (aupairs2usa.com/acform.htm)
Do you require a 'live in' position? or a 'live out' position?
When do you wish to commence employment?
Length of employment:
Salary / Pocket Money required:
Please specify destination of your choice: 1st Choice:
2nd Choice:
3rd Choice:
Do you prefer townor countryside?

Family Background
Father's Profession:
Mother's Profession:
Parent's address (if you are not living at home):
Parent's telephone number(if different from above):
Do you have any Brothers or Sisters?		yes no
If yes, please give details of their ages and professions:

Education/Employment details
Last School / College / University attended:
Examinations / Qualifications obtained:
(Not applicable to British Nationals), How long have you studied English? Basic Fair Good
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 Childcare, Housework and other details
	Experienced with:	Comfortable with:	Willing to work with families:
	0-6 months	0-6 months	of a different race
	6 months-1 year	6 months-1 year	of a different religion
	1-2 years	1-2 years	with a single mother
	2-5 years	2-5 years	with a single father
	5-10 years	5-10 years
		mentally handicapped
		physically handicapped
If you have had any experience with children please supply childcare references:

Type of housework done?
Type of cooking done?
Are you in good health?		yes no
If not, from what do you suffer?
Do you have any allergies?		yes no
If yes, what allergies do you have?
Do you have a criminal record?		yes no
If yes what were you convicted of?
Do you eat everything? yes no
If no, what do you not eat or what are your dietary restraints (eg religious)?
Do you smoke? yes no If yes then how many per day?
Would you agree not to smoke in the family's home? yes no
Which sports do you play?
Do you play a musical instument and if so, which instument?
Do you like animals?		yes no
If yes, which animals do you like?
Do you have a driving licence?		yes no Date test passed
Would you drive abroad?		yes no
Please give details of hobbies or interests and/or any further information that you feel might help us find the right position for you:

Upload a photograph of yourself and/or of you with children or babies maximum size of picture should be approximately 1 megabyte or 1,000kb each the larger the file the longer you'll have to wait for it to upload
1st image file:
2nd image file:
3rd image file:

If you have any further pictures or Scanned images of documents as needed below, please also upload them here
4th image file:
5th image file:
6th image file:
Declaration
I fully understand the Agency's conditions and agree to abide by these conditions. Furthermore, all the details given by me on this application form are correct.
* I agree to the above declaration


Additional items that you will be asked to send by post or email when this form is positively processed
1. One pleasant passport photographs with your name on reverse.
2. At least two 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 two references (i.e. child-care, character reference, employer, teacher etc.)
6. If you have requested a Nanny placement, copy of NNEB or similar certificates, should accompany your application form.
7. A Police Record Check