Name:

Age:

Date of Birth:

Nationality:

Current Address:

Address in your Country:

Telephone No:

Mobile:

E-mail:

Position applying for:

Do you live with your family:

Father's Occupation:

Mother's Occupation:

Do you have brothers:

If yes, age of brothers:

Do you have sisters:

If yes, age of sisters:

Your Height:

Your Weight:

When do you leave school:

Qualifications:

Religion:

When can you start work:

For how long do you want a job:

Do you have a driving licence:

Would you drive in the United Kingdom:

Do you have a criminal record:

Have you been in trouble with the police:

Can you swim:

Do you like pets:

How good is your spoken English:
(excellent, good, average, poor, none)

How good is your understanding of English:
(excellent, good, average, poor, none)

How well can you read English:
(excellent, good, average, poor, none)

How well do you write English:
(excellent, good, average, poor, none)

Tell us other languages that you speak:

Would you like to go to school in England:

Do you smoke:

If yes, do you agree not to smoke in the house:

Would you accept smokers in the family:

Do you suffer from any health problems:
(illness, allergies, epileptic fits, depression)

If yes, please specify:

Are you mentally or physically disabled:

Are you on a special diet:

If yes, please give details:

Have you had an infection in the last year:

If yes, please give details:

Have you worked as an au pair before:

If yes, when and where:

Have you any experience looking after young children:(babysitting, changing nappies, making children a meal, etc)

What is the age of the youngest child you have experience in caring for:

What is the maximum number of children you would look after:

Please tell us the age of the children you would prefer to work with:
(0-3 years, 3-5 years, 6+ years)

Of the following, which of these do you feel confident doing:(Simple Cooking, Ironing, Bed Making, Laundry, Vacuuming, Pet Care, Babysitting)

Please tell us your hobbies and interests:

Please give any information which may be useful:

• Please note that you will need a medical certificate from your doctor.
• Please find out from your embassy if you need a visa.
• Please send a photo of yourself; two references; a medical from your doctor and a "Dear Family" letter to: Alison@crownaupairs.com
• You are responsible to pay for your transportation to England.
• The family will pay you pocket money, provide accommodation and all meals.
• We suggest to bring extra money if possible, for emergencies, etc., as England is rather expensive should a situation arise.