Northern Au Pair Agency

Au Pair Application Form

Save and complete a copy of this form for your records and then e-mail to napag@btinternet.com or post back to

The Northern Au Pair Agency, 13 Danesway, Prestwich, Manchester M25 0ET           

Surname:

First name(s):

Age:

Address:

Post code:

Home telephone:

Mobile phone:

E-mail address:

Nationality:

Religion:

Date of Birth:

Are you employed at the moment?

Occupation:

Parents’ Occupation:

Details of brothers and sisters:

Ages:

Your knowledge of English is: Good    Fair    Little

How long have you studied English?

Do you wish to attend language classes in the UK?

Schools / Colleges attended:

Educational qualifications:

Do you have a driving licence?

How long have you held your driving licence?

Would you drive in England?

Do you have any driving experience?

Do you smoke?

Can you avoid smoking during your au pair stay?

What are your hobbies and interests?

Can you swim?

Do you have any allergies?

Are you a vegetarian?

Do you have any other dietary restrictions?

Do you have any physical disability?

How much of experience have you had in the following?:

(a) Cooking

(b) Household tasks

(c) Laundry / Ironing

Can you look after: Babies?

Children under 5 years old?

Children over 5 years old?

Would you be willing to care for a handicapped child?

Please describe your experience with caring for children:

Would you prefer a placement in: A City    Suburb    Rural Area

When do you wish to start as an au pair?

How long do you wish to stay, or until what date?

What is your reason for wanting to be an au pair?

Have you ever been charged with or convicted of a criminal offence?  If YES, please give details:

I have read, understood and agree to the above conditions and confirm that the information I have given in this form is true.

 I have not withheld any information which could affect my placement as an au pair.

Signed:                                                                           Date: