Pre-Application Form
(Pre-Application form for Au Pair position in the USA)
Note: This is for UK and other European Community Nationals only
Please complete this pre-application as carefully and in as much detail as possible.
It is very important that we have an accurate picture of your child care skills.
boxes with asterix * must be filled in
Family Name:
*
Forename/s:
Street address:
Town/City:
Postcode:
Country:
Home Telephone (including STD code):
Alternate Telephone (including STD code):
email address:
Birthdate:
Nationality:
Present Occupation:
Driver's Licence:
Yes No
Date of test:
Smoker:
If yes, how many per day?:
Level of Spoken English:
Fluent Good Fair
Level of Education Completed:
Secondary School
1-2 years University/College
2-3 years University/College
3-4 years University/College
Dates of Availability:
Earliest I can depart:
Latest I can depart:
Child Care Experience
Experienced with:
Comfortable with:
Willing to work with families:
0-6 months
of a different race
6 months-1 year
of a different religion
1-2 years
with a single mother
2-5 years
with a single father
5-10 years
mentally handicapped
physically handicapped
Do you have 200 hours experience with children under the age of two?: YesNo
Please list any relevant skills or qualifications that you feel would be useful in your role as an Au Pair:
Describe your past child care experience:
Why do you want to spend a year in the United States as an Au Pair?:
AuPairs 2 USA, 5 Parklands, Blossomfield Road, Solihull, B91 1NG
Tel: 07973 886 979 Fax: 0121 233 9731
email:
For those who wish to print out and fill in their forms by hand, please click on one of the formats below
Solihull Nanny Agency
Edgware & Solihull AuPair Agency
AuPairCare USA