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Please tell us your first name:

Name of husband or partner:

What is your surname:

What is the surname of your husband or partner:

Nationality of family:

Home Address:

Home Telephone No:

Work Telephone No:

Mobile Number:


Would you be able to submit a family photo:

Do you have a house, bungalow or flat:

How far do you live from the nearest shops:

How far do you live from the nearest
bus stop or station:

Number of bedrooms:

Number of bathrooms:

Request for Au Pair, Au Pair Plus,
Carer or Housekeeper:

Names of Children:

Age of Children:

Do you have a newborn due:

If so, when is your due date:

What are your childrens' personalities:

Do you or your children have
medical conditions or allergies:

If so, please specify:


Are you religious:

If English is not the main language
spoken at home, please state:

If you work, what is your occupation:

What hours do you work:

What is your partner's occupation:

Please tell us the duties you
would expect from your au pair:

Please give brief details of the duties expected:

Please state the hours you expect
your au pair to work (be specific):

Please state the hours you expect
your au pair to work on the weekends:

Monday to Friday the working hours are:

Saturday and Sunday the working hours are:

Extra hours or babysitting would be needed on:

When will the au pair have
time for school and leisure:

What days will the au pair have off:

What kind of pets do you have:

Would you accept an au pair who smokes:

Do you need an au pair who drives:

If you need your au pair to drive, would she/he
have access to a car in their own time:

What kind of car will she/he have access to:

Do you have other help in your home:
(housekeeper, cleaner, etc.)

Please describe your au pair's accommodation
(television, private or shared bathroom, desk, etc)

Would your au pair have access
to a computer/Internet:

When do you require your au pair to start:

Minimum length of time you
would consider employment:

How much pocket money would you be
willing to provide to your au pair:

Will you be prepared to pay extra for
extra hours your au pair may work:

Would you offer to pay for school or anything else:
(example: gym membership or travel home)

Please tell us your family interests:

Please tell us of any nearby schools:

Please tell us of local places of interest:

What is your nearest airport:

When your au pair arrives would you
pick her/him up or send a taxi:

Would you accept a male au pair:

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