PARENTS
FIRST ADULT
First Name Middle Name Surname
Date of Birth - Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959
Nationality Albanian Austrian Australian Belarusian Belgian Bosnian British Bulgarian Canadian Croatian Czech Danish Dutch Estonian Finnish French German Greek Hungarian Icelandic Irish Italian Latvian Lithuanian Norwegian Polish Portuguese Rumanian Russian Serbian Slovak Slovenian Spanish Swedish Swiss Turkish Ukrainian USA Other If other, please specify Mother Tongue Albanian Belarusian Bosnian Bulgarian Croatian Czech Danish Dutch English Estonian Finnish Flemish French German Greek Hungarian Icelandic Italian Latvian Lithuanian Norwegian Polish Portuguese Rumanian Russian Serbian Slovak Slovenian Spanish Swedish Turkish Ukrainian Other If other, please specify
Smoker? No Yes Occupation
SECOND ADULT
Age Nationality Albanian Austrian Australian Belarusian Belgian Bosnian British Bulgarian Canadian Croatian Czech Danish Dutch Estonian Finnish French German Greek Hungarian Icelandic Irish Italian Latvian Lithuanian Norwegian Polish Portuguese Rumanian Russian Serbian Slovak Slovenian Spanish Swedish Swiss Turkish Ukrainian USA Other If other, please specify Mother Tongue Albanian Belarusian Bosnian Bulgarian Croatian Czech Danish Dutch English Estonian Finnish Flemish French German Greek Hungarian Icelandic Italian Latvian Lithuanian Norwegian Polish Portuguese Rumanian Russian Serbian Slovak Slovenian Spanish Swedish Turkish Ukrainian Other If other, please specify
Any relevant information about yourself, your partner and your family (including number and type of pets).
Any details concerning your hobbies and lifestyle that you think are important for the Au Pair to know.
YOUR CHILDREN
Child
Age - Months
Age - Years
Gender
Need Aupair?
Special Needs?
CONTACT DETAILS
Address Line 1 Line 2 Line 3
Town/City Province/County Postcode
Phone Number
Mobile Number
E-mail
Skype Name
Google IM Name
Windows Live Name
WHAT TYPE OF HELP YOU NEED
Do you need a Nanny?
Would you like advice before deciding whether your require an Au Pair or a Nanny?
OFFER TO THE AU PAIR / NANNY
(Fill in as appropriate) Can you offer/allow:
To pay for the travel to the UK?
To pick up the Au Pair from Airport/Station?
The Au Pair to attend a language school nearby?
To contribute to Language School fees if necessary?
Access to a private phone?
Access to Internet?
Offered weekly pay (Pounds per Week)
What else would you offer to the Au Pair / Nanny?
FAMILY REQUIREMENTS
The Au Pair / Nanny has to start on Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2009 2010 2011
Duration of stay Up to Three Months Up to Six Months Up to One Year Up to Two Years
The Au Pair / Nanny will work up to 25 hours 25 to 35 hours 35 hours plus a week
The Au Pair / Nanny has to:
- Be of a specific Gender Girl Boy Either
- Profess a Faith No Yes Not Important If yes, Which one
- Be a Non-Smoker Not Important Yes
- Be a Vegetarian No Yes Not Important
- Be trained/knowledgeable in First Aid No Yes Not Important
- Be a swimmer No Yes Not Important
- Have a valid driving licence No Yes Not important
- Have previous experience as an Au Pair No Yes Not important
- Come with your family on Holidays No Yes Not important
- Give also household help No Yes Not important
- Help/Babysit also during evenings/weekends No Yes Not important
- (If yes) How many evenings a week One Two and weekends a month One Two
What else do you need the Au Pair / Nanny to do?
REQUIRED KNOWLEDGE OF LANGUAGES
Level of of knowledge of English Mother Tongue Fluent Intermediate Basic
First other language? Albanian Belarusian Bosnian Bulgarian Croatian Czech Danish Dutch English Estonian Finnish Flemish French German Greek Hungarian Icelandic Italian Latvian Lithuanian Norwegian Polish Portuguese Rumanian Russian Serbian Slovak Slovenian Spanish Swedish Turkish Ukrainian Other Level of Knowledge Mother Tongue Fluent Intermediate Basic
Other requirements (Including more details on languages, faith, etc if not already stated)
How did you do find us? Google Search Yahoo Search MSN Search Ask Search Mumsnet Facebook MySpace Other Social Network Gumtree Other Post Site Yell Thomson Local Other Directories Told by a friend Other If Other, which one:
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