| Last
(family) name |
|
First
name |
|
| House
no. / name, Street |
|
|
|
| State/County |
|
Zip/Post
Code |
|
| Contact Tel. |
|
Country |
|
| Email
address |
|
Marital
status |
|
| Father's
occupation |
|
Father's
nationality |
|
| Mother's
occupation |
|
Mother's
nationality |
|
| Religion |
|
Ethnic origin |
|
| Number
of children |
|
Age & Gender
of children |
|
| Earliest
start date (DDMMYY) |
|
Latest
start date (DDMMYY) |
|
| Age
preferred |
|
Au pair from
(1st
choice) |
|
| Driver
required |
|
(2nd choice)
|
|
|
Length
of stay
|
|
(3rd choice)
|
|
|
On which days will the au pair be required
to work (please tick appropriate boxes)
|
Monday
Tuesday
|
Wednesday
Thursday
|
Friday
Saturday
|
Sunday
(per week)
|
|
Pocket money
|
|
|
Any
other details (job role / hours; family's hobbies; etc.).
|
|
| Please enter the name and email address of a former
au pair, or family acquaintance, who can supply a character reference. |
| Name |
|
Email address |
|
|
Please choose a password, to enable you to access your details on-line.
(At least 6 characters, and no more than 12 characters. Spaces are not allowed.)
|
|
Password
|
|
Verify
password
|
|
