Family Application Form

Personal Information

Please attach a photo of your family from your hard disk as "jpg" or "gif", max. 15 Kbyte.
Picture too big? Minimise it here

Surname:

First Name of Mother:

First Name of Father:

Home Address (including post code):

County:

Country

Telephone number at home (including all codes):

Daytime/Office telephone number (including all codes):

Mobile number:

Fax number either/both at home and at office (please state to whose attention fax should be sent to):

E.Mail address

Marital status:

Single
Married
Living with partner
Divorced
Widowed

Children’s name(s), age(s), and sex:

Are you expecting a baby? If ‘yes’ when is it due?

Mothers nationality:

Mothers occupation and hours away from home:

Mothers religion:

Fathers nationality:

Fathers occupation:

Fathers religion:

Please describe the significance of Religion in your home:

How many adults live in your house (if you have any Grandparents, lodgers, etc living with you)?

Please describe your hobbies and interests, individually or as a family:

Is anyone in the household disabled, or do any of the children have learning difficulties?
If ‘yes’ please describe as best as possible (which child, symptoms, etc).

Family pets:

Do you speak any other languages (other than English) in your home to each other?
Please name the languages and state how often it/they are spoken.

Does anyone in the family speak any other languages other than English (to what level)?

Type of Au Pair required:

Please tell us which type(s) of Au Pair(s) you would consider (the following hours are not inclusive of the 2 nights per week babysitting that may be required):

Demi ( up to15 hours per week) yes no

Regular (up to 25 hours per week) yes no

Au Pair Plus (up to 35 hours per week) yes no

Mothers Help (full time) yes no

Type of stay required:

Temporary (up to 3 months)
Short term (3 - 5 months)
Long term (6 - 8 months)
Long term (8 - 12 months)
Super term (12 months +)

yes
yes
yes
yes
yes

no
no
no
no
no

Would you accept a temporary or short term girl whilst waiting for a long term?

Yes
No
Only during Summer school holidays

Would you expect your Au Pair to be in by a certain time at night, or are you flexible?
If ‘yes’ please specify the hour and whether this is applicable during the week and/or the weekend).

Would you accept a Male Au Pair?

yes
no
preferably
no preference

Au Pairs Duties:

Please state the hours/times au pair will be on duty, as well as the free time (as per a usual day).
Please also describe the duties that you will expect, making clear how much of the work is childcare, and how much is light housework:

Amount of pocket money you will be paying your au pair weekly:

Family Home

Describe your home - e.g. the amount of bedrooms, living rooms, bathrooms, garden, etc.

What appliances do you have in the home (e.g. washing machine, tumble dryer, dish washer)?

Describe Au Pairs accommodation - e.g. single/double, own bathroom, T.V., desk, etc.

Describe the area that you live in e.g. within city, large town, village, by the coast, etc.

How far from the house is the nearest bus stop?

How far from the house is the nearest train/underground station and
what is the name of your nearest train or underground station?

Distance from the house to local shops?

Distance from the house to nearest English class?

Your Au Pair Requirements:

Have you had an Au Pair before?

Yes
No

Minimum Level of English acceptable?

good Average Basic We don’t mind if au pair is a lovely person Please select

Do you need an Au Pair who can drive?
If ‘yes’ please describe the type of driving duties that will be required. Please state whether driving is vital, or if it would be an advantage.

Would you accept a smoker?
(if ‘yes’ please describe under which circumstances is acceptable, e.g. OK in the house, in the garden, socially, away from the house, not around the children, etc)?

Would you accept an au pair with body piercing or tattoos (would this depend on how much is showing)?

Do you need an au pair who can cook
(if ‘yes’ please describe the level of ability that you require)?

Do you have any dietary restrictions in your home (e.g. vegetarian, kosher, etc)?

Would you accept a vegetarian au pair only, or would you accept either a vegetarian and/or meat eating au pair?

Do you have a preference as to where an Au Pair comes from, or are you flexible depending on the applicant?

Are there any nationalities that you will not accept?

Would you accept an Au Pair of a different colour or race (or does this depend on Au Pairs suitability)?

Approximate age of Au Pair preferred (please state if you will be flexible for good applications):

Earliest start date for new Au Pair:

Latest start date:

Minimum length of stay acceptable and length of stay preferred:

Any special requirements that will help us match you with suitable Au Pairs (e.g. swimming, horse riding, etc)?

Please give name, address and telephone number, fax or e.mail of one person to whom The Agency can apply for a personal reference (outside the family):

I give permission to Angels International to display my (anonymous) family details whilst looking for a suitable Au Pair for my family.

Yes
No

AGREEMENT I have read, understood and accept the terms and conditions of business as specified and know that they apply immediately upon requesting the Agency’s service (whether the application form is signed by me, or not). I understand and accept that I am liable to pay the Agency fee immediately upon acceptance of an Au Pair introduced to me by Angels International Au Pair Agency, and that the Au Pair will be treated fairly and with respect. I will not hold Angels International Au Pair Agency liable for any loss, damage or injury caused to persons or property from any act or omission on the part of my Au Pair, or for any contractual difference for the Au Pair from a co-operative Agency. I understand that if my Au Pair’s stay with me is extended, I must inform Angels International Au Pair Agency immediately and that I am liable to pay any difference in fees arising from such an extension. Should we host an au pair through the agency whether directly or indirectly or be re-engaged by us at any stage I will notify the agency immediately and could be liable to pay fees. I declare that this information is true and correct. I acknowledge that any information given to me about potential au pairs of the agency or other applicants is highly confidential and I agree not to divulge any such information to anyone without The Agency consent.