AU PAIRS Unlimited

7 Donovan Avenue, LONDON N10 2JY
Tel: +44 (0)20 8374 0182

REGISTRATION FORM

NAME __________________________________________________________

ADDRESS _______________________________________________________

________________________________________________________________

________________________________________________________________

TEL NO: ________________________ FAX NO: ________________________

TYPE OF HELP REQUIRED _____________________
(Demi Au Pair, Au Pair, Au Pair Plus or Mother's Help)

POCKET MONEY/SALARY TO BE PROVIDED _____________________

LENGTH OF STAY REQUIRED ___________ Minimum __________ Maximum

STARTING DATE REQUIRED ______________

NUMBER OF PERSONS IN HOUSEHOLD ________ ADULTS ________ CHILDREN

Description of Your Children:

NAME / AGE / SEX / SCHOOL-HOURS

________________ / _____ / _____ / ___________________

________________ / _____ / _____ / ___________________

________________ / _____ / _____ / ___________________

________________ / _____ / _____ / ___________________

Miscellaneous:

YOUR OCCUPATION _______________________________

BUSINESS TEL ____________________ FAX NO ___________________

YOUR PARTNER'S OCCUPATION ___________________________

BUSINESS TEL _____________________ FAX NO ____________________

NATIONALITY OF FAMILY ________________________

RELIGION OF HOUSEHOLD _______________________

LANGUAGES SPOKEN __________________________

ANY PETS ____________________________________

Duties to be Covered:

CARE OF NEWBORNS ____ CHILDREN AGED 1-3 _____ 3-5 _____ OVER 5 _____

ALL CLEANING __________ SOME CLEANING ___________

WASHING __________ IRONING __________ SEWING __________

COOKING FOR THE FAMILY ________ FOR THE CHILDREN __________

CARE OF ANIMALS ______________________________________________

WORKING DAYS PER WEEK ____________________________________

WORKING HOURS PER DAY ____________________________________

Type of Accomodation Offered:

OWN ROOM _________ OWN BATHROOM _________ OWN TV __________

Description of Your Home:

Flat/House etc. __________________________

APPLIANCES IN HOME: DISHWASHER _______ WASHING M/C _________

DO YOU HAVE OTHER HELP (ie. Daily Cleaner) _____________________________

NEAREST PUBLIC TRANSPORT ____________________________________

CLOSEST ENGLISH SCHOOL (if known) ___________________________________

Please indicate if you have any preferences:

NATIONALITY OF AU PAIR _______________________________________________

SMOKER / NON SMOKER ______________ DRIVER / NON DRIVER _____________

OTHER POINTS OF CONCERN _____________________________________________

_____________________________________________________________________

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SIGNATURE (if posting) _____________________________ DATE _______________

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