Premier Au-Pair Agency LTD

PREMIER AU-PAIR AGENCY

	Application form for Au-Pair

Filling out the form below will send e-mail directly to Premier Au-Pair Agency

First Name

Surname

Address

Address1

Town/City

Postcode

Telephone or Fax Number

Email Address

Age

Date of Birth

Sex

Nationality

Place of Birth

Passport /Id number

Religion

Have you a criminal record Yes No
Are you honeset and trustworthy Yes No

Father's profession

Mothers profession

Brothers's ages

Sister's ages

What is your occupation

How many years have you studied English

Please describe your level of English Little/Fair/Good/Fluent
Little Fair Good Fluent
Speaking
Understanding
Reading
Writing

If you can speak another language please give details

Do you wish to attend English classes Yes No

When is the earliest you would like to start

How long do you wish to stay in England

State if you would accept a family living in London/Another City/Town/Village/Farm/Don't mind

Do you have any health problems state the nature of the problem

Do you have any allergies Yes No
Do you require a special diet Yes No
Are you vegetarian Yes No
Do you smoke Yes No
How many per day

Have you ever been away from home before and for how long

Do play any sports and can you swim Yes No
Do you like pets Yes No

Have you any other interests

Can you drive Yes No

How long have you held a licence

Are you happy to drive in the UK Yes No

Do you like children and what experience do you have of children

Would you accept a family without children Yes No
Would you accept a single Mother Yes No
Would you accept a single Father Yes No
Would you accept a family from a different ethnic origin Yes No
Would you accept a family from a differnet religion Yes No
Is there any type of family you would not accept

Are you capable of assisting with the following
Assisting with the cooking Yes No
Cooking Yes No
Washing Yes No
Ironing Yes No
Housework Yes No
Gardening Yes No

Have you been an aupar before if so where and for how long?

Are you capable of looking after babies
0 to 1 years Yes No
1 to 3 years Yes No
3 to 5 years Yes No
5 to 10 years Yes No

Which ages of children do you prefer

Please supply any special request you may have.

I HAVE READ AND FULLY UNDERSTOOD EVERY QUESTION IN THE ABOVE APPLICATION FORM AND I HAVE ANSWERED IN FULL AND TRUTHFULLY

PLEASE PRINT YOUR FULL NAME

Tel:01299 82 83 83 / 07960 863495
Email aupairs@premieraupair.co.uk

_____________________________________________________________________

Head Office:
Benson's Cottage,
Woodgreen,
Astley, Nr Stourport On Severn,
Worcestershire,
DY13 0RR
Tel: 01299 82 83 83 / 07960 863495

Premier Au-Pair Agency is a trading name of Premier Staff Solutions LTD
Company Number 4499439
Registered in England

Application form for Au-Pair