Registration for Au-Pairs

First Name

Last Name

Nationality

Date of Birth

Religion

Practising

Can you live with a family with different religion?

Yes No

Date available to start

Durations of stay

3 - 6 months
6 months
12 months
12+ months

Contact Details

Address(In home country and UK if applicable)

Postcode

Country

Home Phone

Moblie Phone

E-mail

Information about your health

Height

Are you in good health physically?

Yes No

Are you in good health mentally?

Yes No

Health/Medical conditions

Yes No

If yes, provide details

Information about your family

Parent's Address

Father's Occupation

Mothers's Occupation

Number & ages of brothers & sisters

Childcare and domestic experience

Name

Address

Telephone

Employment/school/college reference:

Have you been an Au-Pair Before?

Yes No

If yes, provide details

Childcare qualifications, if yes, provide details

Experience of caring for children (including brother and sister) provide details of ages

Preferred Age range of children

0 - 2
3 - 5
6 - 12
12 years +

Prepared to look after child(ren) with disability

Yes No

Experience of cooking and housework

Yes No

Willing to do light housework

Yes No

Willing to do cooking/meal preparation

Yes No

Do you have a criminal record

Yes No

If so, please give details

Au Pair/Au pair plus Placement details

Do you smoke?

If yes, are you prepared to smoke outside?

Are you a vegetarian?

Would you live in non-vegetarian home?

Au-Pair Agreement

Please read the following and then sign.

Au-Pair Agreement: (1) I confirm that I have read all the written material provided by the Sunflower Au-Pair Agency in my home country, and that I am eligible to be an au-pair. I understand that the au-pair programme is not a contract of work, but that I am required to show a high degree of responsibility and to take my duties seriously. (2) I confirm that I have answered all questions honestly and that all the information that I have supplied is true. (3) I agree to stay in close contact with Sunflower Au-Pair Agency after submitting my application form. I agree not to travel to my host family until I have received an official confirmation of placement (this is usually in the form of an invitation letter from the Sunflower Au-Pair Agency). (4) I shall familiarise myself with all visa requirements (if any) and obtain necessary documentation. (5) I agree to pay all costs for language courses and travel, to and from host country; including debts incurred (eg telephone bills). I also agree to bring money for emergency expenses. (6) I agree to abide by all rules set by the host family, for example, in relation to not smoking, use of the telephone, visitors and so on. During my stay I shall behave in a manner which does not reflect badly on my host family, host agency and Sunflower Au-Pair Agency. (7) I realise that the success of my au-pair stay depends on my own initiative and I agree to integrate myself in family life and to communicate openly with the family should any problems arise and to actively seek a solution. (8) If no solution can be reached, and I decide to leave the family, I agree to give 14 days notice. I also agree to contact the agency prior to leaving the host family. (9) I agree that on arrival at the host family I shall discuss in detail with my host family, the daily and weekly routine, and my and their expectations of me as an au-pair. I also agree to let Sunflower Au-Pair Agency know of any future holiday/travel arrangements. (10) I shall carry out my childcare/light housework duties to a high standard. I agree to keep my room clean and tidy and to maintain a high standard of personal hygiene. My au-pair duties may be the following:- (10.1) Machine wash clothes; (10.2) Vacuum; (10.3) Clean bathroom, kitchen floor, communal areas and children's rooms; (10.4) Ironing and polishing, care for pets, washing up, bed making; (10.5) Babysitting, sole charge of children overnight; (10.6) Bath children, cook for children and family; (10.7) Breakfast for children; (10.8) Bring and collect children to and from school/nursery. (11) I agree to seek the advice of the host family before administering any form of discipline. I also understand that under no circumstances should I hit the children, shout at them or leave them on their own regardless of their ages. (12) I agree to maintain confidentiality and not to discuss details of my host family's private life.

I, (please state your full name), have read, understood and accepted the above "Au-Pair Agreement": (please tick)

"Submission of your au-pair application form to Sunflower Au-Pair Agency constitutes acceptance of the above Au-Pair Agreement".