Family Application Form

Please complete and submit this form with as many details as possible to enable us to find a suitable applicant. Please include a family photograph where asked.

Boxes with an asterisk * must be filled in.

SURNAME *

FIRST NAME *

Address (house name/number and street) *

Town/City *

Postal Code *

Country *

Home Phone Number *

Mobile Number

Work Number

Skype

Email*

Nationality of Family

Recent Family Photograph

Religion

DO YOU OBSERVE YOUR RELIGION?

YesNo

Primary language spoken at home

Other languages spoken at home

Profession of Wife

DO YOU WORK FULL-TIME OR PART-TIME?

Full timePart time

DO YOU HAVE A WORK SHIFT?

Profession of Husband

DOES YOUR HUSBAND WORK FULL-TIME OR PART-TIME?

Full timePart time

Does your husband have a work shift?

How many adults live in your home?

How many children live in your home?

What is your first child's name?

What is your first child's age?

What is your second child's name?

What is your second child's age?

What is your third child's name?

What is your third child's age?

What is your fourth child's name?

What is your fourth child's age?

What are your family's special interests or hobbies?

Please tell us about your home: (size, house or flat, how many bedrooms, bathrooms, garden, etc.?

Please tell us about the domestic appliances in your home: (washing machine, dryer, microwave, dishwasher, etc.)?

Do you employ other domestic help?

If so, how often?

How many pets live in your home?

What kind of pets do you have?

PLEASE LET US KNOW THE TYPE OF HELP YOU REQUIRE?

au pairau pair plusmother's helphousekeepercleanerelderly carer

APPLICANT REQUIRED?

malefemaleeither

DO YOU REQUIRE LIVE-IN OR LIVE-OUT HELP?

live-inlive-out

WOULD YOU ACCEPT A TEMPORARY APPLICANT?

YesNo

IF SO, WHAT IS THE MINIMUM LENGTH OF STAY YOU WOULD REQUIRE?

What is the required date of commencement?

Length of Employment?

How much pocket money per week will the applicant receive?

How much free time will the applicant receive per week?

What time will the applicant commence work?

What time will the applicant finish work?

What will be the applicant's total number of working hours per week?

Please tell us your requirements regarding the applicant's duties?

MUST THE APPLICANT HAVE KNOWLEDGE OF ENGLISH?

YesNo

IF YES, PLEASE TELL US THE LEVEL OF ENGLISH REQUIRED?

basicfairgoodexcellent

IF LIVING IN, WOULD THE APPLICANT LIVE AS PART OF THE FAMILY?

YesNo

WOULD THE APPLICANT HAVE HIS/HER OWN BEDROOM?

YesNo

DO YOU REQUIRE A NON-SMOKER?

YesNo

WOULD YOU ACCEPT A SMOKER IF HE/SHE AGREES NOT TO SMOKE IN YOUR HOME?

YesNo

DO YOU REQUIRE THAT THE APPLICANT DRIVE?

YesNo

Please include any other details that you think would assist us in finding the right applicant for you:
(e.g., Incentives / Bonuses / Holidays / Use of car / Phone calls paid / Travel card, etc.)

PROPOSED TIMETABLE OF DUTIES AND FREE TIME FOR THE APPLICANT:

Morning *

Afternoon *

Evening *

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Saturday *

Sunday *

What is the name of your nearest language school?

What is the distance to the language school from your home?

IN CASE OF AN EMERGENCY, PLEASE SUPPLY THE FOLLOWING CONTACT DETAILS:

Contact Name

Phone Number

Mobile Number

How did you hear about Crown Au Pairs?

Will you go to the airport or station to pick up your applicant, or will you pay for transportation to your home

Nearest Airport

Nearest Railway Station

Nearest Underground Station

SINGLE FATHERS WILL BE REQUIRED TO SUPPLY TWO CHARACTER REFERENCES.

I agree to give two weeks' notice should I wish to terminate the employment of my applicant. However, I reserve the right to discharge the applicant in the case of my finding him or her dishonest, or having mistreated any member of my family, or indeed of any serious misconduct.

Please read and state that you agree to the above terms: *

I shall also notify Crown Au Pairs immediately if there are any changes to the information already given on my application form.

Please read and state that you agree to the above terms: *

Although great care is taken by Crown Au Pairs in the preparation of details of applicants, and they are submitted by the agency in good faith, I understand that Crown Au Pairs shall not be held responsible for the accuracy of this information, and furthermore I agree that Crown Au Pairs will have no liability whatsoever, or however, for any loss, damage, injury, or expenses incurred by me, or any other person arising directly or indirectly from any act or omission of any applicant engaged through the agency, or otherwise arising in respect of engagement of any applicant.

Please read and state that you agree to the above terms: *

I agree to the Scale of Charges and the Terms of Business:

Please read and state that you agree to the above terms: *

Electronic Signature: (please state your name) *

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