|
Please complete all questions |
| Au
Pair placement required |
Au Pair Summer - 2 - 4 month placement |
Au Pair Bronze - up to 6 months |
|
Au Pair Silver - more than 6 months |
|
Au Pair Gold - Fast Track Service |
|
| Start
Date |
|
| Duration
of Stay |
|
|
| First
Name |
|
| Family
Name |
|
| Address
Line 1 |
|
| Address
Line 2 |
|
| City |
|
| Country |
|
| Postcode |
|
| Nearest
Airport |
|
| Home
Telephone |
|
| Work
Telephone |
|
| Mobile
Phone Number |
|
| Fax
Number |
|
| E-mail |
|
|
| Husband's
Occupation |
|
| Husband's
Nationality |
|
|
| Wife's
Occupation |
|
| Wife's
Nationality |
|
|
| Marital
Status: |
Married |
Divorced |
|
Separated |
Widowed |
|
| Please
give name, date of birth and sex of child. |
|
|
| Do
you have any children with a handicap or disability? |
Yes
No |
|
| Family
Hobbies |
|
|
| Religion
of Household |
|
| Languages
Spoken |
|
|
Requirements |
| Would
you prefer a smoker or non smoker? |
Smoker |
Non Smoker |
|
| Do
you require a driver? |
Yes
No |
| Do
you provide a car? |
Yes
No |
| Do
you require a swimmer? |
Yes
No |
Would
you accept an Au Pair who
did not speak very good English? |
Yes
No |
| Do
you object to a vegitarian Au Pair? |
Yes
No |
| Do
you have any domestic help? |
Yes
No |
|
About your home |
| Do
you have any pets? |
Yes
No |
|
| Please
state the distance from your home to the nearest:- |
| Bus/Train
station |
|
| English
School |
|
| Shops |
|
|
| How
many bedrooms do you have? |
|
|
| Is
there a separate room for the Au Pair? |
Yes
No |
|
| Please
describe the Au Pair's accommodation in full.
ie. own toilet, bathroom, television, radio
etc |
|
|
Please
outline duties
(describe a typical day for your Au Pair) |
|
|
| Average
working hours per day? |
|
| Average
working hours per week? |
|
| Number
of evenings babysitting a week? |
|
|
| Would
you accept a male Au Pair? |
Yes
No |
|
| Pocket
Money (Home Office recommend £65 a week) |
|
|
| Have
you engaged an Au Pair before? |
Yes
No |
| If
yes, how many and what nationality? |
|
|
Additional
Information |
| Additional
Information |
|
|
| Where
did you hear about Au Pairs Direct? |
|
|
|
|
| Type
of card |
|
| Card
Number |
|
| Start
Date |
|
| Expiry
Date |
|
| Issue
Number |
|
| CSC |
| It's the 3-digit number printed on the back of your card.For American Express, it's the 4-digit number on the front. |
|
|
| I/We
declare that the above information is true
and correct and any untrue statements may
stop all placements. I/We have read the terms
and conditions of the agency and agree to
adhere to them. The registration fee is enclosed
with this registration. |
|
|
|
Accept |
|
|
|
