Au Pair Registration Form

Date

Weekly Wage

Surname

First Names

Address

Home Tel No.

Work Tel No.

Mobile No.

Email Address

You must include an email address to complete registration.

Mother:
Nationality

Occupation

Father:
Nationality

Occupation

Children:
Name, Age and Sex

Are You expecting a baby during the Au-Pair’s Stay?
Yes No

Family Pets

Family Hobbies/Interests

How many hours is the Au Pair required to work per week?

Mornings

Afternoons

Evenings

Babysitting evenings per week

Free days per week

Other Domestic help employed?
Yes No

Describe your home (no. of rooms etc)

Describe the Au-Pairs accommodation

Is there a bicycle available for the Au-Pair?
Yes No

Distance/Transport available?

Nearest available public transport?

Shopping distance?

Do you require a Female or Male au pair?
Female Male

Do you need an Au-Pair who can drive?
Yes No

If yes, are you prepared to pay for some driving lessons for the Au-Pair to adapt to driving on the left?
Yes No

Is the car an automatic or manual?
Automatic Manual

Do you prefer a non smoker?
Yes No

Length of stay?

Earliest starting date?

Latest starting date?

Have you had an Au-Pair before?
Yes No

REFERENCE
Please give the name and address of one professional person whom we can apply for a reference (outside the family).

Name

Address

Tel No.

Name

Date