A-One Au Pairs & Nannies

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Federation Of Small Businesses Member

Please complete all sections

Full Name:
Home Address:
Telephone Number inc Area code.:
Mobile phone no:
email address:
Date of Birth:
Nationality:
Height:
Weight:
Religion: Observant:	Yes No
Do you have a full Driving licence: If yes. For how long:	Yes No years
Do you smoke:	Yes No
Would you be willing to give an undertaking not to smoke whilst in a family's home or caring for their children:	Yes No
Note: If you give this undertaking, failure to comply could result in instant dismissal.
Are you in good health:	Yes No
Note: A medical certificate will be required at a later date
Have you had any medical treatment in the past three years:	Yes No
Please give details of any medical conditions that my affect you during your stay:
Do you have any criminal convictions:	Yes No Note: A Police certificate will be required for all Mother's Help and Nannies

PLEASE COMPLETE THE ABOVE APPLICATION FORM AND SUBMIT TO OUR AGENCY.

IF YOU ARE NOT SURE OF AN ANSWER THAT IS REQUIRED ENTER 'DON'T KNOW'

WE WILL THEN SEND YOU A MORE DETAILED APPLICATION FORM FOR YOU
TO COMPLETE, AND ARRANGE FOR YOU TO BE INTERVIEWED.