Hire an Au Pair

Request an Au Pair

Family Surname
Your name and partner's name
Full Address, including post code
Town, City or Village?  Town City Village
Nearest Airport
Home Phone
Office Phone
Mobile
Email
Skype ID
Start Date
Your Occupation
Your Age
Your Nationality
Partner's Occupation
Partner's Age
Partner's Nationality
If either nationality is NOT British, does the partner hold a British Passport?
If Yes, on what date was the passport issued?
Marital Status
Family Hobbies
Family Religion
Languages Spoken

Accommodation

Type of House
No of Bedrooms
Please describe Au Pair's accommodation in full (en suite bathroom, own room/radio/television etc)

Children

Child/Children's Name(s) and Gender(s)
Child/Children's Age(s)
Do any of your children have any handicaps or disabilities?
Are you expecting a baby?  Yes No
If yes, when is the due date?

Household

Is yours a smoking or non-smoking household?  Smoking Non-Smoking
Would you accept a smoker if they agreed never to smoke in the house, or in front of the children?  Yes No
Will you accept a male Au Pair?  Yes No
Do you require a driver?  Yes No
Do you require a swimmer?  Yes No
Do you currently employ domestic help?  Yes No
List any pets and whether or not the Au Pair will be expected to help with them
Will the Au Pair have access to the Internet?  Yes No
Nearest Transport (bus/train service etc)
Nearest Shops

Language Classes

Nearest College
Details of language classes and cost

Average Working Hours

Per Week
Per Day
Days Off

Au Pair duties and requirements

Please outline Au Pair's daily tasks/duties:

Morning
Afternoon
Number of evenings baby-sitting
When do you reqire an Au Pair?
For how long?

Information for the Au Pair

Will you collect from airport/station?  Yes No
Nearest Airport/Station
How much pocket money will your Au Pair receive? We recommend £80.00 per week for 25 hours

Please attach a family photograph for the Au Pair (can be done later if preferred):

Family Photograph (max 500kb) (accepted file formats: jpg, jpeg, gif, png)
Please give the name, email and address of someone who can provide a family reference
Have you engaged an Au Pair before?  Yes No
If Yes, how many?

Nationality Preferred

1.
2.
3.

How did you hear about us?

Are you using other agencies?

Agreement to Agency Terms

I/We declare that the above information is true and correct  Accept
I/We have read the terms and conditions of the agency and agree to adhere to them  Accept

If you would like a printed copy of this form, please click here