Please state your preferences
Au Pair 20-25 hoursAu Pair Plus 30-35 hoursMothers Help 35-45Summer Au Pair 25-35Nanny 35-45 hours

Personal information

Photo of yourself (upload) (Each photo uploaded should be 2mb or less)

Last name

First name

Date of birth
MaleFemale

Address:

Nationality:

Marital Status
SingleMarriedDivorced

Mothers Profession:

Fathers Profession:

Do you have any brothers and sisters (specify ages)
YesNo If Yes, Please specify age

Parent(s) Telephone no:

Religion
Practising YesNo

Phone (Home)

Phone (Mobile)

E-mail

Skype ID

Information concerning your Au Pair /Mothers Help stay

Availability

Start Date

Length of Stay
2-3 months6 months6-12 months12 months

Would you accept a country / village location providing you have access to language classes?
YesNoNot Important

I have experience of caring for children with these ages and would prefer to work with children aged (you can select more than one):
0-1 years1-2 years3-6 years7-10 yearsover 10 years

I would like to look after (you can select more than one):
1 child2 children3 children4 children4+ children

Do you accept the following chores (you can select more than one):
light houseworkironingcookingboxes for laundrysupervise homeworkhelp with shoppingcaring for pets

Do you have any pets at home?
YesNo If yes, please state which one

Education/Qualifications

What is your English
NonebasicFairGood

Do you speak another language? If yes state which ones and the level
NonebasicFairGood

Do you wish to attend English language courses?:
YesNo Day Time Classes OnlyEvening classes onlyEither

Do you have any childcare qualifications
YesNo

Do you have a first aid certificate?
YesNo

Tell us about your special hobbies and interests are (incl playing a musical instrument / sports)

Can you swim?
NoYes

Do you have a full driving licence?
NoYes

Date you passed driving test

Would you drive during your stay?
NoYes

Health

Do you Smoke?
NoYes

Do you suffer from any mental or physical health problems? Please state also if you are currently taking any medication form a Doctor
NoYes

If yes, please give details:

Are you a vegetarian or Vegan?
NoYes

If yes, please give details:

Are you allergic to any of the following?
foodplantsanimalsmedicationinsectschemicals

Have you ever been convicted of a criminal offence inc driving offences?
NoYes

If yes, please give details:

Any additional information:

I declare that all the details given by me on this registration form are correct

Please upload (1-3) family photos/photos with friends etc
(Each photo uploaded should be 2mb or less)

Please Upload Medical Reference
(Each photo uploaded should be 2mb or less)

Upload 2 Childcare references
(Each photo uploaded should be 2mb or less)

Upload a Police Check
(Each photo uploaded should be 2mb or less)

Upload Character reference
(Each photo uploaded should be 2mb or less)

Upload Child care/first Aid Reference
(Each photo uploaded should be 2mb or less)

Additional items to send by email later or upload now with this form to: info@sunfloweraupairagency.co.uk
1 .A ‘ Dear Family ‘ letter to your host family written in English
2. A CV (curriculum Vitae )
3. 2 /3 photographs of yourself/ members of your family if you wish
4. A medical certificate / reference to say you are fit to work with children
5. 2 References ( Can be from families where you have mcarried out babysitting /childcare/teachers / previous employers
6. Police check (copy )
7.Any first aid certificates / childcare qualifications / driving licence
8. copy of your passport or ID Card

Click "yes" to accept the terms and conditions above*
Yes