Au Pair in England: Family Application Form

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Application For To Employ an Au Pair

This application form is designed to provide as much information as possible about your family. The more we know about your family's needs, the more effective our placement process will be for you.

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FAMILY DETAILS
Title :	Mr & Mrs Mrs Ms Mr Dr.
Marital Status :	Couple Single Mother Single Father
Family Name :
Language(s) spoken at home:
Names & Sexes & Ages of children (Please explain if you are expecting a new baby)
Do you have any special medical requirement or dietary restriction for you or your children?
Any other family members living with you?
Are there any smokers at home?	Yes No

CONTACT DETAILS
Telephone :	Day Time Evening
Mobile :
Fax :
Email :
Address :

MOTHER'S DETAILS
Name
Nationality
Occupation
Religion

FATHER'S DETAILS
Name
Nationality
Occupation
Religion

HOME & LOCATION DETAILS
Where do you live?	Very Rural Area Rural Area Quiet Residential Busy Residential Big Town/City, Main Road
Please explain your home (number of bedrooms & bathrooms, type of property, any amenities at home?)
Please explain if you have any domestic helpers/ employees at home :
Name and distance of the nearest English course to your home?
Please explain the public transport amenities in your area :
Pets at home, please give details :

AU PAIR DETAILS
Would you consider a male au pair?	Yes No
For how long do you intend to host the au pair?
When do you need the au pair?	Earliest Starting Date Latest Starting Date
Please indicate preferred nationalities of the au pairs?

Do you need a driver?	Yes, It is essential It is preferred Unconcerned
Do you require a non smoker?	Yes, S(he) must be a non smoker S(he) can smoke outside Unconcerned
Do you accept an au pair with a basic level of English? Please note 70% of au-pairs have only BASIC levels of English.	Yes No
Will the Au Pair have her own bedroom?	Yes No
Will the Au Pair have her own bathroom?	Yes No
Will the Au Pair have her own TV?	Yes No
Other i.e. streo, use of car, bicycle
Preferred ages of the au pair?
Have you ever employed an au pair before?	Yes No
If yes, how many au pairs did you employ and how long did they work for you?

WORK DETAILS
What's the aupair's main responsibility?	Only childcare Mostly childcare, some housework 50% childcare, 50% housework Mostly housework, some childcare Only housework
Please list all kinds of housework that you expect your au pair to perform and how often Please note Au Pairs are not qualified nannies or domestic servants, they should not be expected to take sole responsibility for the children or household duties.
Weekly Work Schedule ie. Mondays: 7-9am and then 3-6pm Evenings free
Total Working Hours A Week	hours a week
Weekly salary offered Minimum weekly salary for an au pair is £ 65	£ a week

Further Details
Please provide any additional information you feel necessary in processing your application :
How did you hear us?
If other, please specify:

I confirm that I will give a notice of two weeks if I decide to terminate the employment of my au-pair. However, I reserve the right to top discharge the au-pair in the case of a seious misconduct on their part.

I UNDERSTAND THAT THE AGENCY CANNOT BE HELD RESPONSIBLE FOR ANY ACTIONS OF THE AU-PAIRS ENGAGED THROUGH THE AGENCY OR THE ACCURACY OF THE INFORMATION REGARDING MY AU-PAIR ALTHOUGH ALL CARE IS TAKEN TO ENSURE THAT THE APPLICATIONS REFLECT THE TRUTH.

I have read and agreed to the terms & conditions of business.

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