Northern Au Pair Agency

Family Application Form

 

Save and complete a copy of this form for your records and then e-mail to napag@btinternet.com or post back to

The Northern Au Pair Agency, 13 Danesway, Prestwich, Manchester M25 0ET

Personal Information

Name:       

Address:       

Post code:      

Home telephone:      

E-mail address:      

Business telephone:      

Mobile phone:         

Household Information

Husband / Partner Occupation:      

Nationality:      

Work:                             (e.g. full time, part time)

Wife / Partner Occupation:      

Nationality:      

Work:                             (e.g. full time, part time)

Marital status:                                                

Religion of Household:      

No. children in family:      

 

Please state names and ages of children:      

 

About your home

Where do you live?   (e.g. city, suburb,  rural area)

     

What kind of property do you live in?  (e.g. house, apartment)      

Number of bedrooms      

Number of bathrooms      

Nearest language school and distance if known:      

 

Other local amenities:      

 

 

Nearest city:      

Nearest public transport:      

Do you require the au pair to drive?      

Will she have use of a car?      

Please confirm the au pair will have their own room:

Will she have her own bathroom?       

Will she have her own television?      

Do you have any domestic help?          If yes, please state:      

Are there any pets in the house?          If yes, any care for pets required?      

Duties required of the au pair

Please give a brief description of the au pair’s duties:      

 

Childcare duties

Take children to / from school  

Tidy and clean               

Cook children’s meals              

Supervise homework      

Supervise bedtime                   

Babysit  

If yes, how much?      

Working hours / arrangements

Approx no. hours required a day:      

Au pair’s days off per week:      

Date you can receive applicant:         

For how many months?            

Weekly amount of pocket money:       (Minimum: £60.00)

Other requirements / notes

Have you had an au pair before?       

Family hobbies and interests:      

Please give name, address and telephone number of a referee:      

 

I / We enclose a deposit of £35.00 cheque *made payable to Mrs. A. Weinberg*, the Balance due on acceptance of applicant of £290.00 together with a letter of invitation and photographs of family.  

 

I / We agree with your terms and conditions and confirm that the above information is correct, and that the hours of duties will not exceed those laid down by the UK Home Office.

 

 

 

 

 

 

 

 

Signed:                                                                               Date:      

 

Please complete your application form completely to ensure

that we can find you the best match of au pair as possible.