FAMILY APPLICATION
FORM
TITLE . ..
SURNAME .
FIRST NAMES ..
DATE OF BIRTH ..
OCCUPATION ..
ADDRESS ...
..Post Code
.
SPOUSE OR PARTNER
TITLE .
SURNAME
FIRST NAMES .
DATE OF BIRTH .
OCCUPATION .
TELEPHONE HOME WORK
FAX (Contact Name) ..
SPOUSE OR PARTNER
WORK FAX (Contact Name)
NATIONALITY(S) . RELIGION ..
LANGUAGE SPOKEN AT HOME ..
CHILDREN
Names Sex Date(s) of Birth
.. .. ..
.. .. ..
.. .. ..
.. .. ..
IS A BABY EXPECTED . WHEN?
DO YOU HAVE ANY PETS?
DOMESTIC HELP EMPLOYED .
DO YOU LIVE IN A: CITY: TOWN: VILLAGE: RURAL
TYPE OF HOME: HOUSE: SEMI-DET: FLAT
BRIEF DESCRIPTION OF HOME (i.e. how many rooms etc.)
...
..
DO YOU HAVE CENTRAL HEATING?
DISTANCE IN KM/ML TO NEAREST: BUS STOP .
TRAIN STATION SHOPPING CENTRE
CINEMA LANGUAGE SCHOOL
DO YOU OR ANYONE IN YOUR FAMILY SMOKE? .
DO YOU HAVE ANY SPECIAL DIETARY REQUIREMENTS
ie Vegan, Vegetarian, Kosher. .
FAMILY INTERESTS AND HOBBIES.
.
.
PLEASE GIVE A BRIEF DESCRIPTION OF DUTIES
EXPECTED OF AU PAIR
..
..
..
DO YOU REQUIRE A DRIVER?
YES NO NOT NECESSARY
DO YOU PREFER A NON SMOKER?
YES NO DONT MIND
AU-PAIR'S DAYS OFF .
LANGUAGE CLASSES: DAY: EVENING:
DO YOU HAVE A PREFERENCE TO NATIONALITY? ..
WHAT PERSONAL QUALITIES DO YOU REGARD AS BEING
PARTICULARLY IMPORTANT TO YOU AS A FAMILY?
.
.
ARE THERE ANY ILLNESSES OR DISABILITIES IN THE
FAMILY THAT THE AU-PAIR SHOULD BE AWARE OF?
.
START DATE FOR AU-PAIR .
LENGTH OF STAY ..
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"I confirm having read the Terms and Conditions printed overleaf and by signing this application I acknowledge that I shall be bound by these Terms and Conditions."
SIGNED
DATE