Family Surname

Parents Names

Sex, Ages and names of Children :
1 child:
2 child:
3 child:
4 child:
5 child:

Address

Address1

Town/City

Postcode

Telephone Home and Work

Email Address

Do you have broadband?

Are you a single Parent, give details


Do both Parents work: Yes No

Husbands Profession

Wifes Profession

Religion

Ethnic Origin

Nationality

Type of applicant required:
au-pair up to 25 hrs pw au-pair plus up to 35 hrs pw live in nanny up to 40 hrs pw

Would you accept a temporary Au-pair Yes No

How long do you wish to engage an applicant

Starting Date

Nationalities Preferred

Age Preferrred


Would you accept a male aupair Yes No
Do you prefer a male au-pair Yes No
Does anyone in your family smoke Yes No
Can the au-pair smoke Yes No
Does the au-pair need to drive Yes No
Will the au-pair/nanny have use of a car Yes No
Will you accept an aupair with basic fair intermediate good to basic fair intermediate good knowledge of English

Details of your home


Do you employ any other domestic help Yes No
Do you have any pets Yes No
If yes, give details

Is your home in a city town village country

Please give an indication of the timetable you expect the au-pair/nanny/housekeeper to work

Salary per week

Duties of the au-pair/nanny/housekeeper

Special interests and hobbies of the family

Would you be prepared to help with the cost of language courses no yes partially maybe

Will you collect the au-pair/nanny/housekeeper from the station or airport
Yes No

Please state the nearest station /airport

Where did you hear about Premier Au-Pair Agency

I agree to the scale of charges and terms of business *

I have forwarded my £10.00 registration fee *

Print your full name here

Please enter any other details you think might assist us in finding the right au-pair for you.

I agree to give 1 weeks notice if I should wish to terminate the employment of my au-pair.
However, I reserve the right top discharge the employee in the case of finding them dishonest, or having mistreated any member of my family, or any serious misconduct.

ALTHOUGH EVERY CARE IS TAKEN BY PREMIER AU-PAIR AGENCY IN THE PREPARATION OF DETAILS OF APPLICANTS AND THEY ARE SUBMITTED IN GOOD FAITH, I UNDERSTAND THAT PREMIER AU-PAIR AGENCY CANNOT BE HELD RESPONSIBLE FOR THE ACCURACY OF THIS INFORMATION OR FOR ANY ACTION OF THE APPLICANTS ENGAGED THROUGH PREMIER AU-PAIR AGENCY.