family online application form
	1a. Your Details Surname First Name Street Town County Postcode Date of Birth Status Married Single Occupation(s) Daytime Telephone Evening Telephone Mobile Telephone Fax Email Address 1b. Your Partners's Details Surname First Name Street Town County Postcode Date of Birth Status Married Single Occupation(s) Daytime Telephone Evening Telephone Mobile Telephone Fax Email Address 2. Your Family Number of people in household Children Adults Children's details (Please provide name, age and sex) Child 1 Child 2 Child 3 Child 4 Do the children attend school/nursery Yes No How far is the school/nursery from your home Any other relevant information regarding the children (Special needs, allergies, handicapped children) Nationality Religion Ethnic Origin Please Select >>UK/IrishEuropeanAfricanAsianOther Language(s) spoken at home Are you expecting a baby (If yes, please state when) Any pets in the Household (If yes, please state what pets you have) Are any family member's vegetarian/special diets etc (If yes, please give details) 3. Your Requirements Type of help required Please Select >>Au pairAu pair plus Earliest start date Length of stay required Minimum Stay Maximum Stay Hours of work required per day Pocket money to be provided £ per week Describe your au pair's accommodation and facilities Own room Yes No TelevisionYes No Own BathroomYes No Radio / Hi-FiYes No Use of computerYes No Describe her/his typical daily duties i.e. Child Care, School runs, Dusting, Hovering, Washing, Cooking Simple Meals, babysitting Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you have a preference for gender Female Male Minimum Au Pair age Do you require a driver Yes No Will s/he have use private use of a car (If yes, please state if petrol will be paid for) Will the au pair have 1 or 2 driving lessons Yes No Would you accept a smoker Yes No Will you help pay for school fees Yes No Have you employed an au pair before If yes, please state when Will the Au pair have sole charge of the baby/child Yes No 4. Your Home Type of home No of bedrooms Do you have a garden Yes No Do you have any other domestic help (i.e. cleaner) If yes, please give details Do you live in City Town Country Please give the rough distances for the following: Nearest train/bus station Nearest airport Nearest city/town Au pairs English school Do any members of your family have a criminal record If yes, please give details Please state here any other information about your family that may aid us in finding the best possible au pair for your family. For example any hobbies or interests you may have. Thank you for taking the time to fill out this form. In order that we can improve our service to you, please can you let us know how you heard about e-aupairs. 5. Declaration I have read and understood the Terms & Conditions 6. Send Application Click "Send" to submit your application.