Larah Au-Pairs
Employment Agency
21 Fenwick Close
Woking, Surrey
GU21 3BY
Tel:01932 341704
Fax:01483 740544
Email:info@larahaupairs.co.uk
Please complete and then press the submit button at the bottom of this page.
APPLICATION FORM
Name:
Surname:
Nationality:
Date Of Birth:
Telephone:
Email Address:
Position Required:
Au Pair
Mother's Help
Nanny
How Long Do You Wish To Stay?
When Do You Wish To Start As An Au Pair?
Do You Wish To Attend Language School?
Y
N
Have You Lived Abroad Before?
Y
N
How Long Have You Lived Abroad Before?
Religion:
Do You Smoke?
Y
N
How Many?
If Requested, Are You Prepared Not To Smoke In The House Of The Family?
Y
N
Do You Drive?
Y
N
How Many Years Have You Driven For?
Are You Willing To Drive In England?
Y
N
Any Criminal Convictions?
Y
N
Father's Occupation:
Mother's Occupation:
Brothers:
Age:
Sisters:
Age:
Present Occupation:
Profession:
Student:
Education Exams Passed:
How Long Have You Studied English?
Spoken Ability:
Fluent
Good
Basic
Slight
Have You Studied Any Other Languages?
Y
N
Hobbies And Interests:
What Hobbies And Interested Do You Have?
Can You Swim?
Y
N
Do You Like Animals?
Y
N
Do You Have A Valid Passport?
Y
N
Do You Have Any Medical Problems, Diets Or Allergies?
Are You A Vegetarian?
Y
N
General State Of Health:
Height:
Weight:
Are You Taking Any Medication?
Y
N
If Yes, Specify:
Are You Asthmatic?
Y
N
Are You Prepared To Stay With A Single Parent Family?
Y
N
Are You Willing To Stay With A Family Of A Different Faith?
Y
N
Are You Willing To Assist With:
General Housework:
Yes
No
Sewing:
Yes
No
Vacuuming:
Yes
No
Basic Cooking:
Yes
No
Ironing:
Yes
No
Washing:
Yes
No
What Experience Do You Have With Housework?
Have You Ever Taken Care Of Children While You Were Alone?
Y
N
How Many?
What Age Were They?
Have You Ever Taken Care Of New-Borns?
Y
N
Babies Of 6-24 Months?
Y
N
Do You Know How To Change A Nappy?
Y
N
Do You Know How To Bath A Baby?
Y
N
Do You Enjoy Playing With Children?
Y
N
Do You Feel Confident Enough To Be In Sole Charge Of The Children?
Y
N
Is There Any Age Group Of Children You Do Not Wish To Help With?
What Is The Maximum Number Of Children You Wish To Care For?
Are You Flexible About Hours Required?
Y
N
Are You Familiar With First Aid?
Y
N
Do Your Parents Approve Of This Type Of Work?
Y
N
Would You Accept To Live In: London/Town/Village?
Y
N
What Are Your Reasons For Coming To England?
Any Other Information Relevant To This Application?
I Declare That All The Information Provided Is Accurate:
Date:
Signature:
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