| YOUR
GENERAL DETAILS |
| Family
Name |
|
House no./name, Street |
|
| Town / City |
|
County / State
|
|
| Post/Zip Code |
|
Country |
|
| Daytime
Tel. |
|
Evening
Tel. |
|
| Fax
No. |
|
Email |
|
| Mother's
name |
|
Father's name |
|
|
Mother's nationality |
|
Father's
nationality |
|
| Mother's
occupation |
|
Father's
occupation |
|
| Marital status |
|
Number of children |
|
| 1st
Child's Name |
|
1st
Child's date of birth |
|
| 2nd
Child's Name |
|
2nd
Child's date of birth |
|
| 3rd
Child's Name |
|
3rd
Child's date of birth |
|
| 4th
Child's Name |
|
4th
Child's date of birth |
|
| Ethnic
Origin |
|
Religion |
|
| YOUR
REQUIREMENTS |
|
What language level does the au pair need? |
|
How long do you wish to engage an applicant |
|
|
Earliest start date (DD/MM/YYYY) |
|
Latest start date (DD/MM/YYYY) |
|
| Age
Preferred |
|
Will
accept (male/female) |
|
|
I have no preference as to where the au pair is from (subject to legal visa restrictions) |
|
OR |
|
I only wish to receive details of candidates with the following mother tongues / languages (please tick as appropriate): |
|
English
French
Spanish
German
Portuguese
|
|
OR |
|
I require an au pair from: |
|
|
|
|
(Asterisked (*) countries do not have visa agreements with the United Kingdom.) |
| Is
a car driver essential? |
|
Will
the au pair have the use of a car? |
|
|
Please give an indication of which days and the total weekly hours that the au pair will be required to work. (Tick boxes as appropriate.) |
| Monday |
|
Tuesday |
|
| Wednesday |
|
Thursday |
|
| Friday |
|
Saturday |
|
| Sunday |
|
|
|
| Hours per week |
|
Pocket
money per week |
|
| Supplementary
duties of the au pair (for children only) |
Cooking
Laundry
Ironing
|
Light housekeeping
Food shopping
|
| Does
anyone in the family smoke? |
|
May the au pair smoke? |
|
| HOME
DETAILS |
| Is
your home in a... |
|
Do you have a garden? |
|
| No.
of bedrooms |
|
No.
of bathrooms |
|
|
Please confirm that the au pair will have their own room: |
|
Other facilities available to the au pair: |
|
| Do
you employ any other domestic help?
(If yes, please give details.) |
|
Details:
|
| Do
you have any pets? (If yes, please give details.) |
|
Details:
|
| How
far to the nearest shops? |
|
How
far to the nearest bus stop? |
|
| How
far to the nearest station? |
|
