Au Pair Application Form
 

GENERAL INFORMATION

Family Name

 
First Name
Adress
 
Gender
 		 Date of birth
 dd/mm/yy

Telephone
 		 Mobile
Email
 		    
Nationality
 		 Religion practice
Available from
 		 Duration
Occupation
 		    
Degree/Diploma/
Certificate
 
Parent’s Names
 
Parents or next of Kin address (If different of yours)  
  
Mother’s Profession Father’s Profession
 
Brothers and Sisters’

Have you lived away from home before?

 		  
Have you been an Au Pair before?
 
 		 if yes; when, where and how long?
Do You Smoke? if yes how much per day?

(Au pairs can be dismissed if found smoking inside the house without the parents permission)
 
Do you have any Allergies?
 
Do you have any food restrictions?
 
Do you have a serious relationship
 		    
Your knowledge of English Is
 

 
Knowledge of other Languages
 
Do you want to attend English classes?
 		  
Would you accept a family of different ethic origin?
 
Do you have a full driver license?
 		 When passed?
How often do you drive?

Daily

 Several times per week
 		 No often
Are you prepared to drive in the UK
 		  
What are your hobbies and interests?
 
 
Why do you want To become An Au Pair?
 
 
Do you have criminal record
 		 Details
Do you have any
childcare certificate?
 		 Details
Do you have a First Aid Certificate?
 		    
Addition details additional information to help us fine the right family for you
Do you have childcare experience with children  Newborn Ages 1-2 Ages 3-5
  Ages 6-10 Ages 10-15 Disabled
 
Age of children
preferred
 		 No of children preferred
Would you be prepared to care for a Disabled Child?
Experience in housework Shopping Cooking Ironing
  Use the washing
     machine		 Vacuuming Dusting
Would you consider the following families
 		 a single mother a single father Family without  
    children
Hours work per day
 		 4/5 6/7 8/9 10/11 Any  

All au pair must be prepared to baby-sit 1 / 2 evening a week between Monday & Thursday and sometime at weekends in special circumstances. Au Pair must also be prepared to care for children during school holiday
 
Would you accept a placement
 		 In a city    Suburb /Town     Village      Anywhere
Are you willing to live with family who has Dog    Cat    Bird    Small household pets
       
       
Documents to be provided: 2 colour photo of
      yourself		 Medical report Police check report
    Dear family letter 2 childcare references
 
Passport/ID Card Driving Licence
       
Other relevant documents
       
Attached documents    

AGREEMENT:

  • I declare that all the information I have provided or will provide to the MKelly Aupair Agy is true and correct
  • Before I undertake a placement I will familiarise myself with all the conditions of the host family such us working hours, duties, pocket money, time off, holiday, language courses, transport costs, location
  • I understand that I will have to help the family with light housekeeping. I will keep my room tidy and will contribute to the tidiness of common areas of the house.
  • I will not take anything without asking,
  • I am clean and tidy and I will follow basic hygiene rules.
  • I will not discipline children in any way, unless advised by parents
  • I understand that while the children are under my supervision, I will never leave them alone or unsupervised.
  • Should any problems occur, I will communicate with my family as soon as possible, or I will contact MKelly Aupair Agy to speak to someone in confidence
  • If I decide to leave the family, I will give them at least 2 weeks notice. During this period I will carry on with my duties and behave normally. The family will continue to provide me with a room, board and pocket money.
  • I will not undertake any other employment without the family’s agreement. I will not take on any employment if there are visa restrictions.
  • I understand that the placement will be terminated if:

    1. I break the family rules
    2. I break the rules of the au pair program
    3. My visa expires
    4. I have not provide truthful information on my application

Your Name (Compulsory):

Your Email Address (Compulsory):

  

M Kelly Au Pair Agency.
17 Ingram Way, Greenford, Middlesex UB6 8GQ
Phone/Fax: 020 8575 3336 Mobile: 07932 673557

 Contact us on Phone/Fax 020 8575 3336
e-mail us on info@mkellyaupair.co.uk