simplyaupairs.com Family App Form
Surname:
Names:
Address (1st line):
Address (2nd line):
Town:
County:
Postcode:
Telephone Home:
Telephone Work:
Telephone Mobile:
Fax:
Email:
Mother's Occupation (Full / Part Time):
Father's Occupation (Full / Part Time):
Family Nationality:
Ethnic Origin:
Family Religion:
Languages Spoken:
Name, age, date of birth of children:
At Nursery/School or at Home?
Is a new baby expected?
Does anyone smoke?
Family Pets:
Children's Hobbies & Interests:
Family Hobbies:
Family Disability or Medical Conditions:
Type of House:
Location
City
Town
Village
Rural
Is the family vegetarian?
Yes
No
Will Au Pair have own bedroom?
Yes
No
Facilities available for au pair?
Childcare Needed:
Au Pair
Au Pair Plus
Au Pair Couple
Weekly pocket money - Au Pair 25hrs
Weekly pocket money - Au Pair + 25hrs+
Weekly pocket money - Couple
Max weekly work hours:
Duties of Au Pair:
No. evening babysitting required:
Confirm 2 days off per week:
Desired childcare experience:
Desired starting date:
Length of stay:
Req skill level (1=high) English:
1
2
3
Req skill level (1=high) Cooking:
1
2
3
Req skill level (1=high) Ironing:
1
2
3
Req skill level (1=high) Housework:
1
2
3
Any other requirements?
Would you consider a smoker?
Yes
No
Would you consider a vegetarian?
Yes
No
Preferred nationality of Au Pair?
Would you accept male Au Pair?
Yes
No
Can Au Pair attend language classes?
Yes
No
Will you contribute to class costs?
Yes
No
Do you require a driver?
Yes
No
May Au Pair use car in free time?
Do you employ anyone else?
Does anyone else live with you?
Yes
No
Please give details:
What can Au Pair do in free time?
Any other information:
Name of personal referee (non-family):
Referee address:
Referee phone no:
Relationship to you:
Where did you hear of our service?
simplyaupairs.com terms of business:
Signed:
Date of application: