About You
*
First Name
*
Surname
*
Age
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
62
63
64
65
*
Sex
Female
Male
*
Height (cm)
<145
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
>200
*
Weight (kg)
<40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
>100
*
Date of Birth (Day)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
Date of Birth (Month)
1
2
3
4
5
6
7
8
9
10
11
12
*
Date of Birth (Year)
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
197
197
197
197
197
*
Nationality (Country)
Andorra
Austria
Belgium
Bosnia-Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Germany
Greece
Greenland
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Monaco
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Slovakia
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
Religion
Practising
Yes
No
Occasionally
*
I live in (home location)
*
Type of Location
City
Town
Village
Rural/Farm
Contacting You
Telephone no
Mobile no
Fax no
Email address
*
Address
Address(During College)
*
Prefer Contact Method
Mobile/SMS
Email
Post
Telephone (Landline)
Photographs
Photographs can be very important. The more you are able to provide the better. If you are unable to upload photographs at this stage don't worry - they are not necessary to complete your registration but will help a lot.
Photograph 1
Photograph 2
Photograph 3
Photograph 4
Your Current Situation
*
You are...
Attending School/Collage
Working(complete section below)
Unemployed
*
Highest qualification
Primary school
High school diploma
Secondary school
Secondary Grammar school
Bcc degree
University degree
Masters degree
Doctorate
If Working Give Details Below
If Studying Give Details Below
About Your Own Family
Father's Job
Father's Age
<34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
>70
Mother's Job
Mother's Age
<30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
>70
Age of brother 1
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of brother 2
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of brother 3
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of brother 4
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of sister 1
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of sister 2
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of sister 3
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Age of sister 4
<1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
>60
Languages
*
Number of years of English study
<1
2
3
4
5
6
7
8
9
10
>10
*
How would you rate your English skills
Basic
Fair
Good
Fluent
*
Studying English in the UK
Yes
Possibly
Not sure
No
I plan to attend language classes in the UK
I wish to take qualitications in English in the UK
Other Languages Spoken
Level Spoken
Years of Study
Fluent
Excellent
Good
Fair
Basic
<1 year
1-3
4-6
7+
German
French
Spanish
Italian
Hungarian
Russian
Polish
Czech
Slovak
Romanian
Driving
*
Have you passed a driving test?
Yes
No
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
*
International Driving Licence?
yes
no
*
Licence of European Union?
yes
no
*
How often do you drive?
Every day
3-4 times a week
1-2 times a week
1-2 times a month
Few times a year
I can't drive
Your stay in the UK
*
Earliest Start Date - Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
*
Year
2006
2007
2008
2009
2010
Latest Start Date - Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2006
2007
2008
2009
2010
*
Preferred Period of Stay - in months
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
>24
*
Can this be extended?
yes
no
By how many months?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
>24
*
Are you able to stay in UK over?
summer holiday
Christmas
Easter
*
What location do you prefer?
yes
neutral
no
City
Town
Village
Rural/Farm
Preferences for host family
*
Type of family you prefer
yes
neutral
no
Mother/Father+Children
Mother+Children
Father+Children
Mother/Father only
With live-in elderly relative
*
Family Work Arragements you prefer
yes
neutral
no
Both parents working
Mother at home
Father at home
Father away overnight
Mother away overnight
*
Ages of Children Preferred
0-2
2-5
6-10
10+
Don't mind
Preferences for Au Pair Role
*
Type of role you prepared to do
yes
neutral
no
Care for babies
Care for Children
Care for older Children
Care for Disabled Children
Care for Elderly
*
What work are you prepared to do in a family
Light Housework
Washing
Ironing
Shopping (Food/Grocery)
Cooking for Children
Gardening
Handiwork
Driving
Caring for Pets
Cooking for Family
Childcare Experience
*
Do you have any experience with children?
Babysitting
Worked with Children's clubs
Previous Au Pair Experience
Experience Caring for Babies
Experience Caring for 2-5 old Children
Experience Caring for 6-10 old Children
Experience Caring for 10+ old Children
Worked in kidergarten
Worked at a summer camp
Worked at a school
Voluntary work with Children
Professional Childcare Qualification (if yes, specify):
*
Please give details of Childcare Experience (as much as you can)
Hobbies
*
Rate the following hobbies..
Really Enjoy
Quite Enjoy
Neutral
Don't Like
Really Dislike!!
Playing Sport
Watching Sport
Craftwork
Watching TV
Photography
Socialising with Friends
Reading
Listening to Music
Dancing
Drawing/Painting
Pets/Animals
Playing Musical Instrument
Cooking
Walking/Hiking
Computer/Email/Web
Theatre
Cinema
*
Do you play any musical instrument?
yes
no
If yes, please specify (piano, violin, gitar, etc.)
*
What Sports do you like to play?
Aerobics
Cycling
Gym (Weights/circuit training)
Running
Swimming
Horse Riding
Ice Skating
Roller Skating
Badminton
*
Squash
Tennis
Table Tennis
Mountaineering
Hill Walking
Football
Basketball
Volleyball
Hockey
*
Can you swim?
Strong swimmer
Average swimmer
Weak swimmer
Can't swim
*
Do you have First Aid Training or experience?
yes
no
Your Personality
*
What do you think about your Personality?
Quiet
Sociable
Funny
Neat and Tidy
Active
Organiser
Helpful Co-operative
*
Talkative
Like my own company
Caring
Independent
Uses Initiative
Motivated
Sensitive
Warm Hearted
*
Friendly
Strict
Responsible
Flexible
Positive Attitude
Polite
Disciplined
Hard Working
How would you describe yourself?
*
I like to organise things
I like to follow what others are doing
*
I prefer to stay at home
I prefer to go out every evening
*
I don't like untidiness
I am comfortable with a little mess
*
I like to follow rules&guidelines
I like to use my initiative
How long have you been away from home before (in months)?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
>24
*
Does your family support you in this application?
yes
no
List any previous full-time jobs
Personal Likes & Dislikes
*
Do you smoke?
Every day
Sometimes
Socially/Occasionally
Giving Up
No/Never
If yes, are you prepared not to smoke in family home if asked?
yes
no
*
Do you like to socialise?
Every day
A few times a week
Once/Twice a week
When something good is happening
Not often
*
Do you exercise?
Every day
A few times a week
Once/Twice a week
When I feel I should
Hardly Ever
Health and Diet
Any special diet requirements (vegetarian,vegan)?
If vegetarian are you prepared to handle meat and fish?
yes
no
*
If family vegetarian - will you follow a vegetarian diet?
yes
no
*
Do you suffer from any diseases?
yes
no
Asthma
Diabetes
Other
If other, please specify
*
Do you have any allergies?
yes
no
Dairy
Gluten
Nuts
Dust
Pets
Other
If other, please specify
Disclosure
Please write any other details about yourself and any achievements that may support your application (awards, certificates, something you are proud of, etc....)
*
Have you ever had a criminal conviction?
yes
no
If yes, please give more details:
*
Contact name, address and telephone number in case of emergency you are in the UK:
*
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