Surname:

First Name:

Age:

Nationality:

Marital Status:

Date of Birth:

Address:

Mobile:

Landline:

E-Mail:

Religion:

Hobbies:

Present Employment:

Names & Address & Contact No. of Parents or Nearest Relatives:

Father's Profession:

Mother's Profession:

Brothers or Sisters (name, age, sex):

Do you have a criminal record:

State any allergies or health problems:

Do you smoke:

Can you refrain from smoking in the house if required by family:

Do you drive (how long / how often):

Your knowledge of English:

Other languages you speak:

Do you like pets:

Will you look after pets:

Can you cook (how well):

What child-care experience do you have:

Which area / town do you prefer & why:

How long can you stay:

When are you able to start: