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Family Application Form

Please complete the application form below (your details will be treated in the strictest confidence)
Contact Details
Your Full Name
Address
Post code
Home tel
Fax
Work Telephone
E-mail
Who Lives in Your Household
Name(s) of adults in household Occupation
Your Children
Name Age
More About Your Household
What type of accommodation do you live in?
How many bedrooms do you have?
How many bathrooms do you have?
Please give details of any local amenities (shops, bus routes, train stations). Please give approximate distance for each.
If there is a language school near you please give details (and approximate distance if known)
Do you have any other domestic help (please give details)
Pets in the house - please indicate type and number for example:
2 Cats, 1 Dog.
Any other requirements or circumstances that we or the au pair should know about?
Does your family have any special interests or hobbies?
What qualities in an au pair do you think would best suit your family?
What Childcare Duties Do You Require? Please tick all that apply.

Take children to/from school?

Yes

Tidy & clean children’s rooms?

Yes

Cook children’s meals?

Yes

Supervise homework?

Yes

Supervise bedtimes?

Yes

Babysitting (please state hours required)

 Yes How many hours?
Any other information

What Domestic Duties Do You Require? Please tick all that apply.
Wash up/clear after meals

Yes

Ironing

Yes

Help with cooking

Yes

Vacuum

Yes

Dusting

Yes

Tidying

Yes

Care for pets (walking/feeding)

Yes

What other requirements do you have? Please tick all that apply.
Do you require a driver?

Yes

If yes, please confirm that you will provide driving lessons

Yes

Are you willing to accept a male au pair?

Yes

Does anyone in your household smoke?

Yes

Will you accept an au pair who smokes?

Yes - if not in the house or when looking after children

How many hours will the au pair work each week?
What type of accommodation can you provide for the au pair?
Pocket money offered £
Other benefits offered
Date required
Expected length of stay
Have you had a nanny or au pair before?

If you have not had a nanny or an au pair, please provide contact details of a referee who has known you for at least two years (and is not a relative)
Where did you hear of IES Au pairs?
Thank you for your completing this form
I have read and understood the IES Au Pair Guidelines
 Yes
I have read and understood the IES Family Guidelines
 Yes
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