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Please attach a photo of your family from your hard disk as "jpg" or "gif", max. 15 Kbyte
Picture too big? Minimise it here

Your name and surname

Your spouse's/
partner's name and surname

Country

Austria Belgium Canada Denmark Finland France Germany Greece Ireland Italy Luxembourg Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom USA OTHER Please select

Address

CITY or REGION (eg. Hampshire, Essex, Central London, Greater London etc.)

Postcode

E-mail address

Tel. no. day

Tel. no. evening

Fax

Mobile

Gender of Au-Pair required:

female
male
either

Date you would like the Au-Pair to start:

Earliest date: January February March April May June July August September October November December Please Select
Latest date: January February March April May June July August September October November December Please Select

How long do you need an Au-Pair for?

Short-term (up to 5 months)
Long-term (more than 5 months)
Max. period:
Min. period:

Nationalities preferred (in order of preference):

1 2 3

Would you accept any other nationality?

Yes
No

What level of spoken languages do you require from the Au-Pair?

Language 1
Basic
Fair
Good
Either

Language 2
Basic
Fair
Good
Either

Do you require a driver?

Yes (why: )
No

Do you require a nonsmoker?

Yes
No

If yes, would you accept if they agree not to smoke in your home?

Yes
No

If the Au-Pair is vegetarian, would you provide vegetarian meals?

Yes
No
(Any comments: )

Approximate age of the Au-Pair (17-27):

(Any comments: )

Au-Pair's working hours (25-42):

per week

Au-Pair's free days per week:

1 full + 3 half days
2 full + 1 half day
1 full + 2 half days
2 full days
1 full + 1 half day

Au-Pair's pocket money (please state currency):

per week

Au-Pair's duties (please describe specifying the exact DAYS and TIMES the Au-Pair will work(TIMETABLE) (for example MONDAY:
8am-9am get children ready for school, take them to school etc.):

Evening baby-sitting - No.of days/wk:

Number of adults in the family:

Names, ages and sex of children:

Child1: Age:
Name, sex, if at School/Nursery FT/PT :
Child2: Age:
Name, sex, if at School/Nursery FT/PT:

Child3: Age:
Name, sex, if at School/Nursery FT/PT:

Child4: Age:
Name, sex, if at School/Nursery FT/PT:

Is any member of family pregnant and expecting a child during the Au-Pair's stay?

Yes (who/baby due when? )
No

Is any member of family disabled/registered blind?

Yes (who/condition: )
No

Main language spoken in the family:

Any other languages:

Family's nationality:

Family's ethnic origin: (i.e. English, Irish, German, American, Asian, Afro-Caribbean)

Family's religion:

How important is religion in the family's life?
Very Little Not important

Occupation of the mother:

Full-time Part-time Shifts

Occupation of the father:

Full-time Part-time Shifts

Special interests/hobbies of the family:

Do you have any domestic animals?

Yes (which, number, live indoors or outdoors )
No

Any other domestic help which you employ:

Accommodation: (type, no of bedrooms, garden etc)

Description of AP´s room (size, TV, Radio, VCR, etc.)

Will the AP have Internet access at home/public library/ school?

Yes where:
No

Nearest cities (specify names and distance):

Language schools (how many, names if known and distance:

Other facilities in the area(parks, leisure centres, libraries, pubs, restaurants, nightclubs, shopping etc and distance):

Your main expectations of the Au-Pair:

Any other information / Introduction letter for the Au-Pair:

How did you hear about A1 KidsCare UK?

I have read, understood and agree to abide with the A1 KidsCare UK Au-Pair Service Terms and Conditions (you will not lose your info. by clicking on this link)

I agree

Once I accept an Au-Pair, I will pay the service charge by:

Credit card (Visa, Master, Switch, Solo, Delta, JCB or Maestro)
Cheque
Cash

I am interested in (names of Au-Pairs from our website):