Au pair Application Unit

Au pair Application Questionnaire

Be informed that we have received your details from Mason Blake, regarding a pending
job offer as Au pair/nanny to a 5year 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: CAROLYN JANE ABENOJA

Nationality: Date of birth: 01/10/94 Sex: FEMALE

FILIPINO

Marital Status: SINGLE Current Address: DUBAI, UNITED ARAB EMIRATES

Tick the boxes bellow in affirmation.

Do you smoke? YES NO

✓
Have you been to UK before? YES ✓ NO
YES
Will you like to be registered for English classes? ✓ 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: ABENOJA First Name: CAROLYN JANE Other Names: CJ

Mobile Number: +971525946411 Travel Date: MARCH 20,2021 Duration of stay: 2 YEARS

Sign: Date: DECEMBER 21,2020 Time: UAE TIME 2:54PM