Au Pair Registration Form

* = required field

Full Name (Firstname Surname) *
First Name *
Sex *
Height (cm)
Weight (kg)
Date of Birth *  
Nationality (country) *
I live in (home location)
Type of Location
Telephone No.
Mobile No.
Fax No.
Address (during College)
Contact Preference
Contact (2nd Choice)
Photograph 1
Photograph 2
Photograph 3
Photograph 4
Photograph 5
You Are... *
Highest Qualification
If Working Give Details Below
If Studying Give Details Below
Fathers Job
Fathers Age
Mothers Job
Mothers Age
Age Of Brother 1
Age Of Brother 2
Age Of Brother 3
Age Of Brother 4
Age Of Sister 1
Age Of Sister 2
Age Of Sister 3
Age Of Sister 4
Number Of Years Of English Study
How Would You Rate Your English Skills *
I Plan To Attend Language Classes In The UK (study)
I Wish To Take Qualifications In English In The UK
Have You Passed A Driving Test? *
Date Of Issue  
International Driving Licence?
Licence Of European Union?
How Often Do You Drive? *
Earliest Start Date *  
Latest Start Date  
Preferred Period Of Stay - In Months *
Can This Be Extended?
By How Many Months?
Are You Able To Stay In UK Over?
Preferred Locations
FamilyType Preferred
Ages Of Children Preferred
What Work Are You Prepared To Do In A Family
Do You Have Any Experiences With Children?
Childcare Qualification (if yes, specify)
Please Give Detail Of Childcare Experience (please provide as much information as you can)
Do You Play Any Musical Instrument?
If Yes Please Specify (piano, violin, guitar, etc.)
What Sports Do You Like To Play?
Can You Swim?
Do You Have First Aid Training Or Experience?
What Do You Think About Your Personality?
How Long Have You Been Away From Home Before (in months)
Does Your Family Support You In This Application?
List Any Previous Full-time Jobs
Do You Smoke?
If Yes, Are You Prepared Not To Smoke In Your Family House?
Do You Like To Socialise?
Do You Exercise?
Any Special Diet Requirements (vegetarian, vegan)?
If Vegetarian Are You Prepared To Handle Meat And Fish?
If Family Vegetarian - Will You Follow A Vegetarian Diet?
Medical Conditions
If Other, Please Specify Condition
All Allergies
If Other, Please Specify Allergy
Other Information About Yourself (achievements etc.)
Have You Ever Had A Criminal Conviction?
If Yes, Please Give More Details
Contact Name, Address And Telephone Number In Case Of Emergency