family application form for an aupair

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UK Family Application Form

We place au pairs in the UK through our affiliate company, Au Pair in England. It is a sub-division of Language Studies Network Ltd (UK), a registered company in England and Wales.

CLICK HERE for Terms & Conditions
CLICK HERE to print this form (PDF Adobe Acrobat-45 K)

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 tell us if you are expecting a new baby)
Do you or your children have any special medical requirements or dietary restrictions ?
Do any other family members live 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 describe your home (number of bedrooms & bathrooms, type of property, any amenities at home?)
Please tell us if you have any domestic helpers/ employees at home :
Name of the nearest English course and distance from your home:
Please tell us about the public transport amenities in your area :
Please give details of any pets at home:

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 pair? (We cannot guarantee that a particular national will be placed with your family. An au pair will be offered based on their suitability for your family rather than nationality)

Do you need a driver?	Yes, it is essential It is preferred Not important
Do you require a non smoker?	Yes, S(he) must be a non smoker S(he) can smoke outside Not important
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. stereo, use of car, bicycle
Preferred age of the au pair:
Have you ever employed an au pair before?	Yes No
If yes, how many au pairs have you employed and how long did they work for you?

WORK DETAILS
What is the au pair's main responsibility?	Childcare only Mostly childcare, some housework 50% childcare, 50% housework Mostly housework, some childcare Housework only
Please list all types 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	� a week

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

Security Code
Enter Security Code

I confirm that I will give notice of two weeks if I decide to terminate the employment of my au-pair. However, I reserve the right to discharge the au-pair in the case of serious 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.