Au pair Application Unit
Au pair Application Questionnaire
Be informed that we have received your details from Anthony Holmes, regarding a pending job offer
as au pair to a 3 year old. Kindly fill in the form below detailed information as required for assessment
to enable us compile your requirement checklist as well as job contract letter.
NOTE: Information provided on this form must be valid, very viable and not falsified as traces of
ingenuity will dismiss your application.
FILL THE FORM BELOW USING BLOCK LETTERS.
Name:
Nationality: Date of birth: Sex:
Marital Status: _ Current Address:
Tick the boxes bellow in affirmation.
Do you smoke? YES NO
Have you been to UK before? YES NO
Will you like to be registered for English classes? YES NO MAYBE
Can you swim? YES NO
In the event of Au pair application, the Au pair will be required to prove that he/she is capable to meet
the necessary financial status for entry into the United Kingdom, as well as Au pair/ Care giver
financial status endorsement.
I will be able to meet up with the necessary financial requirements in the course of my application.
Disclaimer: Information as found on this form is not falsified but original and verifiable, as I will be
held responsible if found wanting.
Surname: First Name: Other Names:
Mobile Number:
Sign: Date: Time: