HOST FAMILY APPLICATION FORM
* : required
TITLE*
FAMILY NAME*
EMAIL*
PHONE* with area code please
ALTERNATIVE PHONE with area code please
ADDRESS & POST CODE*
MARITAL STATUS*
Father's/Partner's Nationality*
Mother's/Partner's Nationality*
Which race best describe your
family?
If your origin is not of British
descent, Please provide your country of origin/descent*
Sexes/Ages of Children *
Any other family member who lives
with you? *
Religion of the family?
Do you regularly
attend your religious services?
Pets at home? *
Please give details
about your home *
What Language(s) do
you speak at home? *
Nearest English course details to
your home?*
Where do you live? *
Please explain if you
have any other domestic helper at home?
Is there a smoker at home?
Do you have any
special medical requirement or dietary restriction for any family
members?
Have you
ever used an au-pair before?
For the English course of the Au-Pair,
Please explain public
transport amenities in your area.*
Type of Employee
Required *
What sex Au-Pair are
you seeking? *
For how long do you
need the au-pair to stay? *
When do you need the
au pair to start?
Please give earliest and latest dates to start to work.Earliest Date* *
Can the Au Pair be a
smoker?
Do you need an au-pair
with a driving licence?
Do you accept an au Please note 75% of au-pairs have only a basic level of English
What
is the au-pair's
main responsibility? *
SAMPLE WEEKLY WORK SCHEDULE OF THE AU-PAIR
ie. 8-9am and then 3-7 pm. (2 full days should be off)
Mondays*
Tuesdays*
Wednesdays*
Thursdays*
Fridays*
Saturdays*
Sundays*
Total
Working hours per week?*
Weekly salary offered * £
FURTHER REMARKS Please give details if you have any additional requirements or comments
in this application form
