Name

Address

Home Telephone

Mobile

Work Telephone

E-mail Address

Number of Adults

Number of Children

Name and ages of children

Occupation of parents

Nationality of Parents

Are you a single parent?

Are you expecting a new baby?

What is your religion?

Do you practice your religion?

Summarise familiy interests and hobbies

Please outline any health issues or special needs

How many bedrooms in your home?

Please briefly describe your home and facilities

Please describe the accommodation for the Au Pair

Do you have any pets? (Specify)

How far is your home from transport links and facilities (e.g. bus, shops, college)?

Would you consider contributing to the Au Pairs travel costs to the UK?

Would you be prepared to pay towards local travel costs (buses, trains)?

Are you prepared to contribute towards college classes for learning English?

What type of Au Pair placement do you need?

When would you like the Au Pair to start (month or specific date)

How long would you like the Au Pair to stay?

What is your preferred age range of the Au Pair?

Do you have any strong preferences for the nationality of the Au Pair?

Would you consider a male Au Pair?

Do you need a driver?

Do you need a swimmer?

Would you object to a vegetarian?

Level of English required

Describe the type of personality that would most fit in your family

Please detail any other strong preferences or attributes you need the Au Pair to have

Do you have any existing help, such as a cleaner, childminder, or nanny?

Please specify the total number of hours and the approximate hours per day you require

What type of Au Pair do you need?

How much housework do you require the Au Pair to do?

Please outline the type of housework duties you would expect

Do you require babysitting during weekdays (up to 2 a week)?

Would you consider an Au Pair who only smokes outside of the house?

How much money are you offering per week?

What other incentives (if any) are you offering?

I have understood and accept Rainbow Au Pairs  Terms and Conditions.

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