MIKSO AU PAIR AGENCY Täktholvägen 21, Bäsna, 781 95 Borlänge, Sweden
Phone: +46 (0)243 230298 E-mail: mikso@telia.com
http://www.mikso.se     

APPLICATION FORM FOR THE POSITION OF AU PAIR

Please complete this form as clearly and as carefully as possible in English, giving as much information you can as it will be read by your host family.

Surname:
 __________________ First name:
 __________________
Address:
 __________________

__________________
 E-mail:


Place and date of birth:

 __________________

__________________
Phone:
 __________________ Nationality
 __________________
Mobile:
 __________________ Religion:
 __________________
When can you start?
 __________________ How long do you wish to stay?
 __________________
Name, address and tel no of nearest relative:
(person to contact in emergency):
___________________________________________

___________________________________________

___________________________________________

Parents´ occupation:

___________________________________________
Do you wish to attend English classes?
  • Yes
  • No


    • How many years have you been studying English?

    __________________

    		 How would you describe your spoken English:
  • Poor
  • Adequate
  • Good
  • Very good
    		•
    Please give details of your education, how long you have studied and the examinations you have passed. Any future plans for further education?

    _______________________________________________________________________________________________
    Your present work/studies:

    _______________________________________________________________________________________________

    Would working in a family where the children are out at school all day bother you?

    ___________________________________________

    What age-groups of children do you prefer?


    ___________________________________________
    Please detail any experience you have had looking after children including their ages, sex and what duties you carried out.

    _______________________________________________________________________________________________

    _______________________________________________________________________________________________

    _______________________________________________________________________________________________

    _______________________________________________________________________________________________
    Have you any experience in housework:
  • Ironing
    		•
  • Vaccum cleaning
    		•
  • Dusting
    		•
  • Making beds
    		•
  • Cleaning baths
    		•
  • Cooking
    		•

    How would you describe your health?

    Any allergies? _______________________________

    Do you like animals?

    ___________________________________________

    Do you follow a vegetarian diet?
  • Yes
  • No
    		•  Do you smoke?
  • Yes
  • No

    		•  If you smoke, would you agree to do so only outside the house?
  • Yes
  • No

    		•
    Can you drive a car?
  • Yes
  • No

    		•  If so, would you drive in England/Scotland?
  • Yes
  • No


    		•
    Give details of your hobbies and interests.

    _______________________________________________________________________________________________
    Where would you like to work as an Au Pair?
    England
  • London and suburbs
  • Town
  • Country

    		•  Scotland
  • Town
  • Country

    		•
    Have you ever lived away from your family and friends for any length of time, two months or more?
  • Yes

  • No

    		•  Have you travelled outside your home country?
  • Yes

  • No

    		•  Do you speak any other languages?
  • Yes
    •    _____________
  • No

    		•
    What do you plan to do when you return home after your stay as an Au Pair?

    _______________________________________________________________________________________________

    DECLARATION:

    I declare that the information in the application form, references and letter is correct.
    I understand that I must give two weeks´ notice should I wish to leave the family.
    I understand that the Au Pair agreement is between myself and the host family and that the agency is not responsible if the agreement breaks down.
    I have sufficient money to pay for my return ticket.
    I will also send three photos, a letter to the family, two references and a medical certificate.




    Signed_____________________________________________  Date_____________________________________






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