For more information from the Home Office UK Border Agency click here.
Click here for tips on questions to ask families.


Personal Details
First Name:
Post Code:
Country: (if your country is not on the list, you cannot be registered as an au-pair)
Fax Number:
E-mail Address:
Skype ID
Place of Birth:
Date of Birth:
Ethnic Origin:

Do you practice it:

Visa Expiration:
Marital Status:
Father’s Name:
Father’s Occupation:
Mother’s Name:
Mother’s Occupation:
Name and Age Brothers & Sister:
I’d like to be:  
Date Available:
Minimum length of stay (in months):
Maximum length of stay:
I prefer to be in:
Education and Diplomas:
Additional Qualification:
Languages Knowledge:
(Write the language under the level)
Basic Fair Good Fluent
Childcare Experience

Have you been an Au Pair before?            
(If yes, please tell us when, where, for how long and ages of children)

Do you have any childcare experience?
(Please describe giving type of care, ages of children, etc)

What is your main reason for becoming an Au Pair? (Please use as many words as possible)

Are there any activities you enjoy that would be applicable to the children (Ex. biking, swimming, drawing, painting, cooking, etc?)

More Information about you

Do you have a full driving license? 

When did you get your driving licence?

How often do you drive?

Could you drive an automatic car?

Would you be happy to drive abroad? 

Do You smoke?

If you Smoke, how many cigarettes a day? 

Would you be willing to smoke only outside the house and never in front of the children?  

Would you be willing to give up smoking?

Are you taking any medication? (If yes, please give details)

Are you vegetarian?

If yes, would you live with a family who was not vegetarian, and help them cook fish/meat?

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

Do you have any allergies?                 
(If yes, please give details)

Do you have any dietary requirements? (If yes, please specify)
Do you have any tattoos or piercing? (If yes, please give details)

Previous employment

Current employment

What are you interests and hobbies?

Can you swim?

Do you like sports?

Do you practice any sports?
(If yes, please give details)

Do you have any experience in first aid?  

How would you describe your character?

Polite Patient Mature
Reliable Adaptable to new situations Responsible
Outgoing Family oriented Flexible
Caring Friendly Hardworking
Shy Kind Cheerful
Placement Requirements
Preferred Area

Length of stay

Earliest starting date     

Latest starting date    

Would you be willing to extend your stay?           

(If yes, for how long?)

Age group of children you could look after

Number of children you could look after

Would you accept a family with disable children?

Would you accept a family with learning difficulties children?   

Would you accept families without children?  

Would you accept a single mother family?      

Would you accept a single father family?   

Would you accept an elderly person?

Would you accept a family of a different ethnic origin?     

Would you accept a family of a different religion?  

Do you like animals?           

Is there any animal you would refuse
to look after?

Would you be willing to do the following duties?

Help with cooking

Cooking for children

General housework



Grocery Shopping

Supervise homework

Bathing children

Any other duties related to children

Caring for pets

Do you want to attend language lessons?  

If you are coming in the summer months, do you realize that there are no classes available and that you will be expected to be with the children during the day, especially if the mother is working?

Do you accept that in the summer there is no way to change a family?

Do you have a Criminal Record?
(If yes, please give details)

Name and contact details of a person to contact with in case of an emergency

Is there any other information you feel would be relevant to your application which might help us in finding you the right family

Preferred way of contact 

Telephone Email MSN Skype
References: 1st Reference 2nd Reference
Telephone (Mobile):
How many children:
Age of children:
How long did you work for the family?:

Are you human? 1+3=
I HAVE READ AND FULLY UNDERSTOOD EVERY QUESTION IN THE ABOVE APPLICATION FORM AND I HAVE ANSWERED THESE QUESTIONS IN FULL AND TRUTHFULLY. I accept the terms and conditions of business.* Please scan and email your photo, identification, proof of address and references from places worked and/or character references to