Host Family Form to Register for a Nanny/Mothers Help & Domestic Staff

Family Name
Father
 Mother
Full Address
including Post Code 		Telephone No.
Fax No.
Email Address

Father's Profession Mother's Profession
Place of Work Place of Work
Telephone No.
Fax No.
Nationality

Telephone No.
Fax No.
Nationality

Name(s) and Age(s)
 of Children 		Schools Attended
Children's
 Hobbies/Interests 		Family Hobbies/Interests
Is there a baby due?    Will your employee be left in sole charge?     
Family Religion  
Brief Description of Home Town?       Country?    

   

Do you employ other domestic help?    
Do you have any pets        Nearest rail/bus station
Any children need special care?  If yes, give details
Type of staff required Commencement date
Expected hours How much time off
 is envisaged?
What net salary do you envisage paying?  
Do you require a driver?     Will a car be provided?     
Please give start and finish date for temporary position Start date   Finish date  
Will the employee travel with you on holiday?    
Will you accept a smoker?      
How many evenings baby-sitting will you require?      
Is the position Daily    or    Residential    Own Room     TV/Video       
If residential, what accommodation is provided? Bathroom        Bedroom        
Self contained flat          

A letter from you and a photograph of your family will make the position more attractive.

How did you hear about us?
Please give name and address of a person
 who can provide a family reference
Please give a brief description of duties involved to help us to find a suitable person for you.

AGREEMENT
This is to confirm that I accept and agree to Nanny Connections' terms and conditions of business and fee schedule.  I agree to inform the agency by telephone when I have engaged an employee and to send confirmation in writing within 3 days of such telephone call.

Signed               Dated    

    For your copy, please Print filled-in form before pressing Send Form.

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