If You Are A Single Parent Father , Please Give Details of 2
Contactable References
Reference No 1
Reference No 2
Name
Address
Contact Tel No
Job Title
FAMILY DETAILS
CHILD 1
Name
Age
Boy/Girl
Child 1's school/nursery
hours
CHILD 2
Name
Age
Boy/Girl
Child 2's school/nursery
hours
CHILD 3
Name
Age
Boy/Girl
Child 3's school/nursery
hours
CHILD
4
Name
Age
Boy/Girl
Child 4's school/nursery
hours
CHILD 5
Name
Age
Boy/Girl
Child 5's school/nursery
hours
Do any of the
children have any disabilities or special needs?
If yes, please specify:
Are you currently
expecting a baby?
Due Date:
What is your Ethnic
Origin?
Mother:
Father:
What is your
Nationality?
Mother:
Father:
Religion
Do you attend Religious Services?
Spoken Languages
Has anyone in
household ever been convicted of a criminal offence or have any
prosecution pending?
Does Anyone in the
family smoke?
What are the family
hobbies & Interests?
Does the family have
any special dietary routine?
Any other:
ABOUT YOUR HOME
Where is your house
located?
Describe your home
Nearest
Train/Tube Station:
Nearest
Coach/Bus Stop:
Nearest
International Airport:
Nearest English
School:
Do you have any
pets?
If yes, please specify
Do you have any
domestic help?
If yes, please specify
APPLICANT's
REQUIREMENTS
Are you looking for:
Do you want the applicant to be:
Start Date?
How Long do you wish
to engage applicant?
What level of spoken
English will be acceptable?
Do You require a
driver?
If yes, please specify
Would you accept a
smoker?
Please give details
of previous au pairs/nannies or Mother's Help
What facilities will
be available in the applicant?
Will Applicant be
Allowed to attend Language School?
APPLICANT’S DUTIES
Main Duties - please
indicate:
Getting children
ready for school
Taking children to school
Picking children up from
school
Helping with
homework
Children's meals
Tidying children's
room
Bathing children
Gardening
Looking after pets
Ironing
Hoover/Dusting
Laundry
Babysitting
Please outline a
typical week:
Include the time Au
Pair needs to be ready & time they finish each day.
Also Days off
(normally 2)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How many evenings per week will they babysit?
(For live in au pairs only)
Hours of work per week
Pocket money per week
Any other requirements in respect of the au
pair/mother help
Would you be prepared to assist with the cost
of their language course?
Would you be prepared to assist with the
travel cost?
How did you hear of
M Kelly Agency?
AGREEMENT:
I understand that 'MKelly Au Pair Agency' is
an agency, establishing contact between the Au Pair and me.
I agree to the scale of charges and terms of
business.
MKelly Au Pair Agency under no circumstances
can be held responsible for any loss or damage I may suffer
before, during or after the Au Pair's stay with host Family.
I understand and accept that an Au Pair
introduced to me by MKelly Au Pair Agency will be treated as a
member of my family.
I agree to give 2 weeks notice if I should
wish to terminate the employment of my au-pair.
However, I reserve the right to discharge
the Au Pair in the case of finding them dishonest, or having
mistreated any member of my family, or any serious misconduct.
I have read the above and understood the
conditions of MKelly Au Pair Agency and I declare that the
above information is true.
Your Name (Compulsory):
Confirm
Email Address (Compulsory):
I agree to the Scale of Chrages and the Term & Conditions
of Business.
M Kelly Au Pair Agency.
17 Ingram Way, Greenford, Middlesex UB6 8GQ
Phone/Fax: 020 8575 3336 Mobile: 07932 673557
