In order to be able to find a suitable family for you, please complete and submit this questionnaire, providing as much information as possible. Please send (by post, fax or e-mail) at least 2 recent photographs of yourself, 3 letters of recommendation (from school or previous employer and reference about your childcare experience), certificate of medical examination and a "Dear Family" letter, written in English, describing yourself and the reasons for wanting to work as an Au-Pair. Male applicants are required to provide a criminal check.

Surname:

First name:

Home Address:

If already in UK, give address & tel.:

Fax:

Home Tel.:

Mobile:

E-mail:

Age:

Date of birth:

Nationality:

Sex:

Marital status:

Names & ages of brothers & sisters:

Names, address & tel. No. of parents:

Length of stay (max. 2 years):

Available from:

Education   :

Hobbies     :

Religion    :

Current Occupation:

Do you have a criminal record:

Do you smoke:

If yes, do you agree not to smoke in the house (if required by family):

State of health :

Details of problems if any:

Dietary restrictions (give details if you have any):

Do you drive (if yes how long):

Would you drive in England:

Do you like animals:

If required, would you look after family`s pets:

Which animals do you not like/are afraid of/allergic to:

Will you accept a single parent family:

-mother

-father

Will you accept a family of other origin:

Will you accept smokers:

Describe your experience with children:

Preferred ages:

Max. number of children you can look after:

Are you happy to do housework:

Can you cook simple meals:

How long and where did you learn English:

Have you passed any English exams, which:

Your level of English:

Do you want to attend English classes and/or obtain language Certificate:

Do you play musical instrument:

Do you speak other language:

Previous working experience abroad if any:

Why do you  want to be an au-pair?
Give additional helpful information: