P.O. Box 147, Radlett, Herts, WD7 8WX  TEL: 01923 289 737 (two lines)  FAX: 01923 289 739

EMAIL: info@the-aupair-shop.com  WWW: www.the-aupair-shop.com

Family Application Form

Please complete and submit this form with as many details as possible,
to enable us to find a suitable applicant.
(Also include a Family photograph and send by email attachment or by post)

boxes with an asterisk * must be filled in

*Surname: 

*First Name: 

         

*Address: 

Name or No. 

of house etc  

*City: 

         

*County: 

*Post Code: 

         

*Home  

Phone No: 

Fax: 

 

        

Mobile  

Phone No: 

*email: 

         

Work  

Phone No: 

             

Nationality of Family: 

         

Religion: 

Observant?

  YesNo

          
 

Main language spoken at home: 

         
 

Other languages spoken at home: 

       

Profession  

of Wife: 

   Full time Part time      Shifts? YesNo

Profession  

of Husband: 

   Full time Part time      Shifts? YesNo

        

Number of adults in the family: 

         

Special interests / hobbies of the family: 

       

Details of children

Name: 

Age: 

Date of  

birth: 

Name: 

Age: 

Date of  

birth: 

Name: 

Age: 

Date of  

birth: 

Name: 

Age: 

Date of  

birth: 

Details of any other children: 

         

Details of the house / apartment: 

         

Domestic appliances in the home:  washing machine  drier  microwave  dishwasher

Other Domestic help you employ: 

How  

often?

Domestic animals (pets): 

         

Employee required:  Au Pair  Au Pair +

Mother's Help  Housekeeper

        
 

Applicant required:

Male Female Either

        
 

Accomodation:

Live-In    Live-Out

        

Would you accept a temporary applicant?  Yes No     Minimum length of stay: 

Nationalities 

preferred: 

Approximate  

age of  

Applicant: 

         

Date  

required to  

commence: 

Length of 

employment: 

         

Pocket money per week: 

         

Free time per week: 

         

Applicant’s working day:    Commencement time: 

Finish  

time: 

Total number of hours per week:  

         

Duties of Applicant: 

         

                 Must the Applicant have knowledge of English?  YesNo        Level of English:  Basic Fair Good

  If living in, would the Applicant live as part of the Family?  YesNo       Have own bedroom?  YesNo
 

Do you require a non-smoker?  YesNo

          
 

Would you accept a smoker if he / she agrees not to smoke in  the family home? YesNo
 

Do you require a driver?  YesNo

          
 

PLEASE INCLUDE ANY OTHER DETAILS WHICH YOU THINK MIGHT  

ASSIST US IN FINDING THE RIGHT APPLICANT FOR YOU  

(e.g, Incentives / Bonuses / Holidays / Use of car / Phone calls paid / Travel card etc): 

*PROPOSED TIMETABLE OF DUTIES AND FREE TIME FOR THE APPLICANT:

Day

Morning

Afternoon

Evening

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

PLEASE SUPPLY NAME / ADDRESS / TELEPHONE NUMBER OF THE FOLLOWING:

Doctor: 

Dentist: 

         

Nearest language school: 

distance  

from  

home: 

PLEASE GIVE NAME AND TELEPHONE NUMBER OF AN EMERGENCY CONTACT:

Name: 

Telephone 

Number: 

Mobile:  

 

How did you hear of our Agency?  

       

Will you go to the station / airport to collect your Applicant or will you pay for transport to your home?
 

Nearest airport: 

         
 

Nearest railway station: 

         
 

Nearest coach station: 

distance  

from  

home: 

 

Nearest underground station: 

         
 

If you are a new family applying for an Applicant, or a single father, please provide us with full names, addresses and telephone numbers of two referees, current employer or a professional such as your doctor, or a previous Applicant.
 

1st Referee

Name: 

Telephone  

number: 

   

Address: 

   
   

Relationship: 

         
 

2nd Referee

Name: 

Telephone  

number: 

   

Address: 

         
   

Relationship: 

         
 

SINGLE FATHERS WILL BE REQUIRED TO SUPPLY 2 CHARACTER REFERENCES.

1.  

I, agree to give two week’s notice should I wish to terminate the employment of my Applicant.  However, I reserve the right to discharge the Applicant in the case of my finding him or her dishonest, or having mistreated any member of my family, or indeed of any serious misconduct. *

2.  

I shall also notify the Agency immediately if there are any changes to the information already given on my application form: *

3.  

Although every care is taken by you in the preparation of details of applicants and they are submitted by you in good faith, I understand that you cannot be held responsible for the accuracy of this information and furthermore I agree that you will have no liability whatsoever or however for any loss, damage, injury or expenses incurred by me or any other person arising directly or indirectly from any act or omission of any Applicant engaged through the Agency or otherwise arising in respect of engagement of any Applicant. *

4.  

I agree to the Scale of Charges and the Terms of Business: *

All four of the above terms must be ticked.

 

 

 

 

 

 

 

 

 

 

 

 

 

The Edgware & Solihull Au-Pair Agency Ltd,  PO BOX 147,  Radlett,  Herts.  WD7 8WX
   

Tel: 01923 289737

Fax: 01923289739

        

email:  amanda@the-aupair-shop.com

    For those who wish to print out and fill in their forms by hand, please click on the button below

   

au-pairs4u.com

            
     

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