| Step
2: Complete and submit the application form below |
| Your
name |
|
| Address |
|
| Town/City |
|
| Postcode |
|
| Telephone
number (Home) |
|
| Fax Number |
|
| E-mail address |
|
Are you a single
parent family?
If yes, only complete your details below and not the absent parent's
details |
Yes No |
|
MOTHER
|
|
| Mother's first name |
|
| Mother's nationality |
|
| Mother's ethnic origin |
|
| Mother's date of
birth |
|
| Mother's profession |
|
| Full/Part time |
Full-time
Part-time |
| Usual hours away
from home (include travel time) |
|
| Do you work
weekends? |
Yes No |
| Do you do shift
work? |
Yes No |
| Mother's religion |
|
| Do you regularly
attend religious services? |
Yes
No |
| Mother's native
language |
|
| Other languages
spoken |
|
| Do you smoke? |
Yes No |
| If so, how many per
day? |
|
| Mother's
work telephone |
|
| Mother's work fax |
|
| Mother's mobile |
|
|
FATHER
|
|
| Father's first name |
|
| Father's nationality |
|
| Father's ethnic
origin |
|
| Father's date of
birth |
|
| Father's profession |
|
| Full or part time |
Full-time
Part-time |
| Usual
hours away
from home (include travel time) |
|
| Do you work
weekends? |
Yes No |
| Do you work shifts? |
Yes No |
| Father's
religion |
|
| Do you regularly
attend religious services? |
Yes No |
| Father's native
language |
|
| Other languages
spoken |
|
| Do you smoke? |
Yes No |
| If
so, how many per
day? |
|
| Father's work
telephone |
|
| Father's work fax |
|
| Father's mobile |
|
|
LANGUAGE
|
|
| Is English spoken at
home? |
Yes No |
| If not, what is the
main spoken language? |
|
|
CHILDREN
PLEASE NOTE THAN AN
AU PAIR SHOULD NOT HAVE SOLE CHARGE OF CHILDREN UNDER 2YEARS OF AGE
Please tick the box to confirm that the au pair
will not have sole charge of children under the age of 2 years
|
|
CHILDREN
(please give first name, sex and date of birth of each child)
|
NAME:
SEX: DOB:
NAME:
SEX: DOB:
NAME:
SEX: DOB:
NAME:
SEX: DOB:
NAME: SEX:
DOB: |
| Is a baby expected? |
Yes No |
| If
so
when? |
Day
Month Year |
| Would the aupair be
expected to help look after the baby? |
Yes
No |
| Who is legally responsible
for your children? |
|
| Are any of the the
children disabled or do they have any allergies the au pair
should be aware of? |
Yes
No
(details)
|
|
OTHER OCCUPANTS
|
|
| Are there any other
persons living with you e.g. lodgers or grandparents? |
Yes
No |
| If so
please give their names, dates of birth and their relationasip to
the family |
NAME:
D.O.B: RELATIONSHIP:
NAME:
D.O.B: RELATIONSHIP:
NAME:
D.O.B: RELATIONSHIP:
|
| What hours are they
usually home? |
|
| Will the au pair be
expected to look after them or be responsible for them at all? |
Yes
No |
| If so please state
what is expected of the au pair |
|
|
PETS
|
|
| Do you have any
pets? |
Yes No |
| If so, what and how
many? |
|
| Will the au pair be
expected to care for them? |
Yes
No |
|
HOBBIES
AND INTERESTS/SCHOOLS AND PLAYGROUPS
|
| What are the hobbies
within the family? |
|
|
Comments about playgroup/school/after-school
activities
|
|
|
HOUSE
DETAILS
|
|
| What
sort of area do you live in? |
CITY TOWN
SUBURBS VILLAGE
COUNTRY |
| Do you live in a
house or flat |
HOUSE FLAT |
| How many bedrooms? |
|
| How many
bathrooms? |
|
| Will the
au pair have separate accommodation or a room in the main house? |
SEPARATE ACCOMMODATION
ROOM IN
HOUSE |
| Please describe the
au pair's accommodation: |
|
| PLEASE
NOTE THAT THE AU PAIR MUST HAVE HIS/HER OWN BEDROOM |
| Will
(s)he
be sharing a bathroom? |
Yes No |
Will
(s)he have own:
(please state which) |
TELEVISION
RADIO
CASSETTE PLAYER
CD PLAYER |
| Do you have a
garden? |
Yes No |
| How far from the
nearest public transport? |
|
| How far from the
nearest shops? |
|
| How far from the
nearest college/language school? |
|
| What are the nearest
towns (and how far)? |
|
| Nearest
tube station/line (London only) |
|
|
How long to London and from what station? (Outside London only)
|
|
| What is
the nearest airport? |
|
MANY
AU PAIRS ARRIVE BY COACH INTO LONDON VICTORIA
If it is not convenient for you to collect your
au pair from their arrival point, then you must pay for any
onward travel. Au pairs pay only for their ticket to the host
country. |
|
WORK REQUIRED OF
AU PAIR
|
|
| Will
(s)he
be required to help with any of the following: |
| Washing
& ironing? |
|
| Hoovering &
dusting? |
|
| Basic cooking for
the children? |
|
| Looking after the
children during the day? |
|
| Looking after the
children at night? |
|
Will
(s)he
be required to baby-sit more than two evenings per week on a
regular basis?
|
Yes
No |
|
Please give details of a typical day
|
|
| Do you
require more than 25 hours per week on a regular basis
and if so, how many hours? |
Yes No
|
| Do you
have any other household help? |
Yes No
(Details)
|
|
DETAILS
OF AU PAIR REQUIRED
Please try not to narrow your choices
too much. We will do our best to find someone suitable but cannot
guarantee a perfect match. You should note that some countries are
not permitted by the Home Office. Please speak to one of our
advisers about which countries are permissible.
|
| Do you
require an au pair from a particular country? |
Yes
No
Country |
| Would
you host an au pair without basic knowledge of English but
with very good knowledge of another language?? |
Yes No
(language)
|
|
Preferred age (between 17 and 27)
|
|
| Do you
require male/female/either? |
Male
Female
Either |
| Will you
accept a smoker if they agree not to smoke inside the house or in
front of the children? |
Yes No |
| Do you need a
driver? |
Yes No |
| To drive the
children to school? |
Yes
No |
| Do you have a car
for his/her use? |
Yes No |
| Type
of car ?
(Make/model - Automatic?) |
|
| Will the
car be for the au pair's sole use? |
Yes No |
| If not,
will the au pair be able to use the car during time off? |
Yes No |
| If so,
how often? |
|
| Will
(s)he
have the use of a bicycle? |
Yes
No |
| Preferred starting
date |
Day
Month Year |
| Duration
of stay |
|
Weekly
wage?
(MINIMUM £55 PER WEEK [£65 IN THE LONDON AREA] FOR
UP TO 25 HOURS WORK PER WEEK. CALCULATE EXTRA HOURS AT A MINIMUM OF
£3.00 PER HOUR |
|
| Extras
offered e.g. paid language classes, driving lessons, travel passes? |
|
| Which
two days off (preferably one on weekend) |
and
|
| PLEASE
NOTE THAT THE LAW STATES THAT AU PAIRS SHOULD HAVE AT LEAST ONE
SUNDAY FREE PER MONTH IF THEIR NORMAL FREE DAYS DO NOT INCLUDE
SUNDAYS |
| SPECIAL
REQUIREMENTS OR THINGS THE AU PAIR SHOULD BE AWARE OF E.G.
ALLERGIES, SPECIAL CONDITIONS: |
|
|
| FOR
OUR RECORDS |
|
| How did you
find Need-a-Nanny? |
|
| Please give the
name, address and phone number of someone to whom we may apply for a
family reference |
Telephone |
| IF
YOU CAN, WILL YOU EMAIL US A FAMILY PHOTO SO THAT WE CAN SEND IT TO ANY AU PAIRS YOU
ARE INTERESTED IN |
|
|
|
|