Mother’s Help / Nanny Application Form

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Personal Information
Surname:
First names:
Address:
Telephone: / Mobile:
Email: / Skype:
Nationality:
Religion:
Will you accept a family of any race / religion or ethnic origin?
Height: / Weight:
Age: / Date of birth:
Marital status:(underline) / Single / Married / Relationship / Divorced
Name and contact details of next of kin:
Mother’s occupation: / Father’s occupation:
General Questions
Type of position:
(underline) / Mother’s Help / Nanny
Terms:
(Indicate with X) / Permanent / Temporary
Live-in / Live-out
Full time / Part time
When do you wish to start?
Planned length of stay in UK:
Where do you wish to work?
Do you have a criminal record?
Are you in good health? / Do you have any allergies?
Do you have any special dietary needs?
Do you smoke? / How many a day?
Would you agree not to smoke in the family’s home?
Experience of children ages:(underline) / 0 – 2 / 3 – 5 / 6 – 9 / 10 and over?
State any childcare experience you have, incl. ages of children and references:
Minimum salary required:
(£ per week)
Do you have any children of your own? How old are they?
Do you have any younger brothers or sisters? How old are they?
Do you have a driving licence? / When did you pass?
Would you drive in England?
Can you swim?
Which duties are you prepared to do?
(Indicate with X) / Cook / Tidy / dust
Iron / Laundry
Help with shopping / Babysit
Wash up / Vacuum
Supervise homework / Supervise bedtime
Would you accompany the family on holidays?
Education & Qualifications
Education:
English level: / Basic / Fair / Good
How long have you studied English?
Do you intend to study English whilst staying here?
Other languages spoken:
Current occupation:
Do you have any First Aid or other certificates? (lifesaving, music etc.)
Formal childcare qualifications:
Hobbies & Interests
Tell us something about your hobbies and interests:
Which sports do you play?
Do you play a musical instrument, and if so, which one?
Do you like animals? / Do you have any pets?
What qualities do you find most important in yourself when looking after children? (e.g. reliable, flexible etc.)
Work Experience #1
Name of employer:
Address:
Telephone:
Email:
Position held:
Starting date:
End date:
(at start):
Salary (£ per week):
Duties:
Reasons for leaving
(if applicable):
Work Experience #2
Name of employer:
Address:
Telephone:
Email:
Position held:
Starting date:
End date:
Ages and sexes of children
(at start):
Salary (£ per week):
Duties:
Reasons for leaving
(if applicable):
Work Experience #3
Name of employer:
Address:
Telephone:
Email:
Position held:
Starting date:
End date:
Ages and sexes of children
(at start):
Salary (£ per week):
Duties:
Reasons for leaving
(if applicable):
I declare that all the details given by me on this application form are correct
Name: / Signature: / Date:

Additional items to send with this form:

1. A letter to the Family in English – “Dear Family…”

2. A CV (curriculum vitae)

3. 2 photographs with your name on reverse

4. A medical certificate stating you are fit to work with children

5. At least 2 references from former employers

6. A copy of your school leaving certificates

7. A copy of a CRB(Criminal Records Bureau) check

Please post or email or fax (you cannot fax photos) this application form with all of the accompanying items to:

Swedish Connection Au Pair Agency

84 Fitzjohn AvenueOr email to:

Barnet,

EN5 2HW

England

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