Job Application Form

Please complete this online form with as many details as possible to enable us to find a suitable placement for you.

Boxes with an asterisk * must be filled in.

Personal Details

    Surname (family name): *

    First Names: *

    Address (house name/number and street):

    Town/City:
    Postal Code:

    Country:

    Phone Number (please include the country and area code): *

    Mobile Number (please include the country and area code):

    Email Address: *

    Nationality:

    Height:

    Weight:

    Age:

    Date of Birth:

    Place of Birth:

    Passport or Identity Card Number:

    Recent photographs of yourself and/or with children and babies


    Do you wish to be an au pair, mother's help or nanny?

    au pairmother's helpnanny

    Would you prefer a live-in or live-out position?

    live-inlive-out

    When do you wish to commence employment?

    Length of Employment:

    Salary/Pocket Money Required:

    FAMILY BACKGROUND

    Father's Profession:

    Mother's Profession:

    Parent's Address: (if you are not living at home)

    Parent's Phone Number: (if different from above)

    NEXT OF KIN

    Address (house name/number and street):

    Town/City:
    Postal Code:

    Country:

    Phone Number (please include the country and area code): *

    EDUCATION AND EMPLOYMENT DETAILS

    Last School/College/University Attended:

    Examinations/Qualifications Obtained:

    How long have you studied English? (not applicable to British Nationals)

    Is your English: Basic, fair, good or excellent?

    FairGoodExcellent

    Other languages spoken:

    Please state whether your knowledge of any other spoken languages is: basic, fair, good, or excellent:

    Current Occupation:

    Length of notice to be given:

    Previous Occupation:

    Do you have any First Aid or CPR Certification?

    YesNo

    Do you have any formal childcare qualifications?

    YesNo

    If yes, which qualifications do you have?

    EXPERIENCE WITH CHILDCARE, HOUSEWORK, AND OTHER DETAILS

    Please state if you are experienced or comfortable with childcare:

    Please state if you are experienced or comfortable with housework:

    Please state if you are willing to work with the following:

    Infants (0-6 Months Old)Infants (6-12 Months Old)Children (1-2 Years Old)Children (2-5 Years Old)Children (5-10 Years Old)Families of a different raceFamilies with a single motherFamilies with a single father

    If you have experience with children can you supply childcare references?

    What type of housework have you done in the past?

    Can you cook?

    YesNo

    If yes, please describe your level of expertise, and describe some dishes, etc., you can cook:

    Are you in good health?

    checkbox health exclusive "Yes" "No" ]

    If not, from what do you suffer?

    Do you have any allergies?

    YesNo

    If yes, what allergies do you have?

    Do you have a DBS check?

    YesNo

    If no, what do you not eat, or what are your dietary restraints (such as religious restraints)?

    Do you smoke?

    YesNo

    If yes, then how many per day?

    Would you agree not to smoke in the family's home?

    YesNo

    Do you like animals?

    YesNo

    If yes, which animals do you like?

    Do you have a driving licence?

    YesNo

    If yes, please state the date you passed your test:

    Would you drive abroad?

    YesNo

    Please give details of hobbies or interests, and/or any further information that you feel might help us find the right position for you:

    DECLARATION

    I fully understand the Agency's conditions, and agree to abide by these conditions. Furthermore, all the details given by me on this application form are correct.
    I HAVE ALSO ACCEPTED THE PRIVACY POLICY AS OUTLINED ON THE FOLLOWING PAGE, PRIVACY POLICY.
    I agree to the above declaration (please state that you agree): *

    Electronic Signature: (please state your name): *



    Additional items that you will be asked to send by post or e-mail when this form is positively processed:

    1. One pleasant passport photograph with your name on reverse.
    2. Two references will be required from previous employers with a phone number and e-mail address for each.
    3. A police record check.
    4. A “Dear Family” letter telling us about you, and any childcare and cleaning experience.

    If you have any further pictures or scanned images or documents ready, as needed above, you may also e-mail these at the time you send the photographs to alison@crownaupairs.com