Request an Au Pair
Family Surname
Your name and partner's name
Full address, including post code:
Is it a City, Town or Village?
Nearest Airport
Telephone (Home)
Telephone (Office)
Mobile
Email
Start Date
Husband's Occupation
Husband's Age
Husband's Nationality
Wife's Occupation
Wife's Age
Wife's Nationality
If either nationality is NOT British, does the partner hold a British Passport?
Please Select
Yes
No
If yes, on what date was the Passport issued?
Marital Status
Please Select
Single
Married
Divorced
Seperated
Widowed
Family Hobbies
Family Religion
Language(s) Spoken
Accommodation
Type of house
No of bedrooms
Please describe Au Pair's accomodation in full (en suite bathroom, own room/television/radio etc)
Children
Child/Children's Name(s) and Gender
Child/Children's Age(s)
Does your Child/any of your Children have any handicaps or disabilities?
Is a baby expected?
Yes
No
If yes, what is the Child's due date?
Household
Is yours a Smoking or Non-Smoking household?
Please Select
Smoking
Non-Smoking
Would you accept a smoker if they agreed never to smoke in the house or in front of the children?
Please Select
Yes
No
Will you accept a male au pair?
Yes
No
Do you require a driver?
Yes
No
Do you require a swimmer?
Yes
No
Do you currently employ domestic help?
Yes
No
Do you have any pets and will the au pair be expected to help with these pets?
Will the Au Pair have access to the internet?
Please Select
Yes
No
Nearest transport (bus/train service etc)
Nearest shops
Language classes
Nearest college
Details of language classes and cost
Average working hours
Per week
Per day
Days off
Au pair duties and requirements
Please outline Au Pair's daily tasks/duties:
Morning
Afternoon
Number of evenings baby-sitting
When do you require an au pair?
For how long?
Information for the Au Pair
Will you collect from airport/station
Yes
No
Please state nearest to you
How much pocket money will your au pair received. We recommend £70 per week for 25 hours
A separate letter outlining duties and a family photograph would be ideal for the Au Pair.
Upload family photograph (max 500Kb)
Browse Files
Cancel
of
Please give the name and address of a person who can provide a family reference
Have you engaged an au pair before?
Yes
No
If yes, how many?
Nationality preferred
1.
2.
3.
How did you hear about us?
Agreement to Agency Terms
I/We declare that the above information is true and correct
*
Accept
I/We have read the terms and conditions of the agency and agree to adhere to them
*
Accept
If you would like a printed copy, click on your browser print button before pressing Send.
Send
Should be Empty: