Application Form for An Au Pair Seeking an Au Pair Job

Personal Details

Surname *

First names *

Address *

Post / Zip Code *

Mobile Telephone number *

Country *

Home Telephone Number

Fax Number

Email Address *

Emergency Contact Name *

Relationship to you *

Emergency contact number including international code *

Date of birth *

Age *

Place of birth *

Nationality *

Male or Female *

Passport / ID number *

Passport / ID date of issue *

Passport date of expiry (please enter not applicable if you do not hold a passport) *

Is visa/work permit necessary? *

Marital status *

Position wanted *

When can you start *

Minimum length of stay *

Maximum length of stay *

Your family and yourself

Fathers occupation

Mothers occupation

Number and ages of brothers

Number and ages of sisters

Your level of education, and any certificates

Details of your present occupation

Previous work experience

Have you studied English?

For how long?

Level of spoken English

What other languages do you speak?

Do you wish to attend language school in England?

What experience do you have of working with children? (include children of family and friends)

What housework have you ever done, and how much?

Could you assist with the following?

Cooking Yes
No

Washing Yes
No

Ironing Yes
No

General Housework Yes
No

Have you ever lived away from home before? If so, when, and for how long?

Have you been an Au Pair before? For how long?

Name and Address of previous host family

I'm happy to work with children aged:

(Tick all that apply)

0-1 years Yes
No

1-3 years Yes
No

3-5 years Yes
No

5-10 years Yes
No

10+ years Yes
No

I do not mind Yes
No

I am happy to help with a physically disabled child Yes
No

I am happy to help with a mentally disabled child Yes
No

I would like to stay with a family:

2 adults with children Yes
No

2 adults with no children Yes
No

Single father Yes
No

Single mother Yes
No

With a different religion to my own Yes
No

Will you live with a family with pets? Yes
No

Are there any animals you really dislike?

Would you help with pets (eg. dogwalking) as part of your job? Yes
No

I would like to live in a:

village Yes
No

suburb of city Yes
No

city centre Yes
No

More Information

Do you have any allergies? If so, to what, and to what extent?

Are you under medical treatment for any condition? Please explain.

Are you vegetarian? Yes
No

If yes, will you live with a family who was not vegetarian, and help them cook fish/meat? Yes
No

If no, would you live with a family who was? Yes
No

Are there any foods you never eat, and what are they?

Do you smoke? Yes
No

How many per day

Do you promise not to smoke in the house and in front of the children Yes
No

What hobbies and interests do you have? Can you swim? Play sports? Love Dancing?

Driving:

Do you have a driving licence valid for the UK? * Yes
No

When did you get your driving licence?

Do you have any points or endorsements? Yes
No

If so, how many and for what?

Have you ever driven in the UK? Yes
No

Will you drive in the UK if given practice/lessons by the host family (for experienced drivers only) * Yes
No

And Finally..

Do your family approve of you coming to England? Yes
No

Do you have friends or family currently in the UK? Where are they, and what are they doing?

How did you hear of this Agency? *

What other Au Pair Agencies have you contacted?

Do you wish to register and come to England together with a friend, Yes
No

When exactly do they wish to come to England?

Please give Friends name

Thank you for completing this form. Before you submit it, you need to read the declaration below.

DECLARATION

I CONFIRM THAT ALL THE INFORMATION GIVEN ON MY APPLICATION FORM IS TRUE. I WILL TELL NORMA LEWIS DOMESTIC STAFF AGENCY IF THERE ARE ANY CHANGES TO THIS.
ONCE MY HOST FAMILY HAS OFFERED ME MY PLACEMENT, AND AFTER I HAVE ACCEPTED, I WILL NOTIFY THE DOMESTIC STAFF AGENCY IMMEDIATELY. I WILL NOT START WITH MY HOST FAMILY UNTIL NORMA LEWIS AU DOMESTIC STAFF AGENCY CONFIRMS MY PLACEMENT. WHEN I HAVE RECEIVED THIS CONFIRMATION, AND MADE MY TRAVEL ARRANGEMENTS, I WILL INFORM BOTH MY HOST FAMILY AND THE AGENCY IMMEDIATELY.
I UNDERSTAND THAT I AM TO PAY FOR MY OWN TRAVEL EXPENSES TO MY HOST COUNTRY, AND THAT I MUST HAVE ENOUGH MONEY FOR MY JOURNEY HOME, OR AN OPEN / RETURN TICKET. I WILL BRING SUFFICIENT FUNDS TO COVER UNFORSEEN EMERGENCIES DURING MY STAY.
I UNDERSTAND THAT I AM RESPONSIBLE FOR MY OWN TRAVEL / HEALTH / DENTAL INSURANCE FOR THE DURATION OF MY STAY AS AN AU PAIR.
I WILL ENSURE I HAVE A VALID PASSPORT FOR THE ENTIRE DURATION OF MY PLANNED STAY AS AN AU PAIR. ALSO, I WILL FIND OUT IF I NEED A VISA/ PERMIT, AND SHALL NOT ENTER MY HOST COUNTRY WITHOUT ONE, SHOULD ONE BE REQUIRED. I WILL NOT DO ANY EXTRA WORK THAT IS NOT ALLOWED BY MY VISA / PERMIT.
I WILL PAY FOR MY OWN LANGUAGE CLASSES IF I ATTEND SCHOOL.
I WILL PAY FOR ANY TELEPHONE BILLS INCURRED.
IF I AM UNHAPPY AND WISH TO LEAVE THE HOST FAMILY I WILL TELEPHONE NORMA LEWIS DOMESTIC STAFF IN LONDON. (TELEPHONE 0208 950 8611, MOBILE 07956 894589).
I WILL HAND IN A MINIMUM OF 14 DAYS NOTICE TO THE FAMILY. IF NORMA LEWIS PLACES ME IN ANOTHER FAMILY, I REALISE THIS MIGHT ENTAIL MOVING TO A DIFFERENT AREA.
I AM FAMILIAR WITH, AND AGREE TO ABIDE BY THESE DOMESTIC STAFF PROGRAMME GUIDELINES.
I UNDERSTAND THAT I CAN BE ASKED TO RETURN HOME OR LEAVE IMMEDIATELY IF
- I FAIL TO ABIDE BY THIS AGREEMENT
- I HAVE GIVEN FALSE INFORMATION ON MY APPLICATION FORM
- I START MY PLACEMENT BEFORE RECEIVING MY OFFICIAL CONFIRMATION FROM THE AGENCY.
- I DO NOT HAVE THE CORRECT VISA / PERMIT (IF REQUIRED) FOR THE ENTIRE DURATION OF MY STAY.
- I ENDANGER THE CHILDREN IN MY CARE THROUGH CARELESSNESS OR NEGLIGENCE
- I BREAK THE LAWS OF MY HOST COUNTRY.
SHOULD I CHANGE MY MIND ABOUT BECOMING AN AU PAIR, I WILL NOTIFY THE AGENCY AT ONCE

Once you have submitted the form:

PLEASE WRITE A LETTER, IN ENGLISH, TO YOUR HOST FAMILY ABOUT YOURSELF, YOUR FAMILY, YOUR HOBBIES AND INTERESTS, AND ANYTHING ELSE YOU FEEL THEY MIGHT LIKE TO KNOW ABOUT YOU. PLEASE CAN YOU INCLUDE ANY CHILDCARE / HOUSEWORK EXPERIENCE THAT YOU HAVE.
PLEASE PROVIDE A DOCTOR'S CERTIFICATE TO SAY YOU ARE FIT AND HEALTHY. THIS CERTIFICATE SHOULD STATE HOW LONG YOU HAVE BEEN A PATIENT OF THIS DOCTOR, AND SHOULD STATE BOTH THE DOCTOR'S NAME AND ADDRESS AS WELL AS YOUR OWN.
PLEASE PROVIDE A POLICE CERTIFICATE TO SHOW YOU HAVE NO CRIMINAL RECORD IN YOUR OWN COUNTRY.
PLEASE SUPPLY 2 WRITTEN REFERENCES FROM PREVIOUS PLACES OF WORK, OR FROM PEOPLE WHOSE CHILDREN YOU HAVE LOOKED AFTER. (THESE PEOPLE MUST NOT BE MEMBERS OF YOUR OWN FAMILY). THE REFERENCES MUST INCLUDE THE PERSON'S FULL NAME, ADDRESS, AND TELEPHONE NUMBER. PLEASE STATE WHETHER THE REFEREE SPEAKS ENGLISH. WE CANNOT FIND YOU A FAMILY UNTIL YOUR REFERENCES HAVE BEEN CHECKED.
PLEASE SUPPLY 4 PASSPORT SIZED PHOTOS OF YOURSELF, WITH YOUR NAME ON THE BACK.

SUBMITTING THIS FORM TO BE AN AU PAIR THROUGH THE NORMA LEWIS DOMESTIC STAFF AGENCY SHOWS THAT I HAVE READ, UNDERSTOOD, AND AGREE TO ALL OF THE ABOVE DECLARATION AND WILL PROVIDE ALL THE NECESSARY DOCUMENTS.

Name *

Date *

GENERAL INFORMATION

What Is A Nanny And What Is A Mother's Help

Openings For Agents

Agents Agreement

Testmonials

Families / Jobs Available Now

Applicants Available Now

Useful Contacts And Links

Contact Us

FOR APPLICANTS

FOR FAMILIES

Au Pair, Au Pair Plus, Application Form

Personal Details

Your family and yourself

Could you assist with the following?

I'm happy to work with children aged:

(Tick all that apply)

I would like to stay with a family:

I would like to live in a:

More Information

Driving:

And Finally..

GENERAL INFORMATION

What Is A Nanny And What Is A Mother's Help

Openings For Agents Agents Agreement Testmonials Families / Jobs Available Now Applicants Available Now Useful Contacts And Links Contact Us FOR APPLICANTS

FOR FAMILIES

Au Pair, Au Pair Plus, Application Form

Personal Details

Your family and yourself

Could you assist with the following?

I'm happy to work with children aged:

(Tick all that apply)

I would like to stay with a family:

I would like to live in a:

More Information

Driving:

And Finally..

Openings For Agents

Agents Agreement

Testmonials

Families / Jobs Available Now

Applicants Available Now

Useful Contacts And Links

Contact Us

FOR APPLICANTS