Please attach a photo of yourself from your hard disk as "jpg" or "gif", max. 15 Kbyte (smiling!) Picture too big? Minimise it here
* If you don't have a photo ready, please send it later by E-mail or post (max. 500kb).
Your name and surname
Country
Address:
E-mail address:
Tel. no. day
Tel. no. evening
Fax:
Mobile:
Sex:
Female Male
Which region do you come from:
Eastern Europe Western Europe Other
Nationality:
Your age:
Marital status:
Single Married Divorced
Profession/Occupation:
What languages do you speak?
English None Basic Fair Good
German None Basic Fair Good
French None Basic Fair Good
Spanish None Basic Fair Good
Italian None Basic Fair Good
Sisters' ages:
Brothers' ages:
Mother's occupation:
Father's occupation:
Are you a driver?
Yes No
Are you a smoker?
If yes, would you agree not to smoke in the family's home?
Your diet (i.e. normal, vegetarian, vegan etc.):
Your religion:
Practicing Non-practicing
Special interests/hobbies:
Briefly describe your childcare experience:
Do you have any experience of dealing with children/people with special needs/disabilities?:
Future plans after my au-pair stay:
About your requirements
Date required to start:
Earliest January February March April May June July August September October November December Please Select Latest January February March April May June July August September October November December Please Select
Length of placement required:
Short-term (up to 5 months) Long-term (more than 5 months) Min. period: months Max. period: months
Countries preferred (in order of preference):
1 Austria Belgium Canada Denmark Finland France Germany Greece Ireland Italy Luxembourg Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom USA Please select area 2 Austria Belgium Canada Denmark Finland France Germany Greece Ireland Italy Luxembourg Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom USA Please select area 3 Austria Belgium Canada Denmark Finland France Germany Greece Ireland Italy Luxembourg Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom USA Please select Please select area
Would you accept to work in:
a) any other country? Yes No b) any other area? Yes No c) town? Yes No d)countryside Yes No
Maximum amount of hours you would accept to work (25-42):
per week
How many children would you be prepared to look after?
What ages of children do you prefer?
Would you accept a family of a different race?
Would you accept a family of a different religion?
Would you accept a single father family?
Would you accept a single mother family?
Would you accept a family with domestic animals?
If no, which animals can you NOT accept:
Do you wish to attend language classes?
Introduction letter for the family:
I am interested in (names of FAMILIES from our website):
How did you hear about A1 KidsCare UK?
I have read, understood and agree to abide with the A1 KidsCare UK Au-Pair Service Terms and Conditions (you will not lose your info. by clicking on this link)
I agree
I will also send (by fax, E-mail or post):
Childcare references Reference from a professional person i.e. lecturer or employer and/or from a person who has known you for at least two years Copy of my medical report from the doctor (to prove that I am healthy and able to work with children) Copy of my driving licence Police clearance (evidence that I have no serious convictions which may interfere with my work)
Other:
