Registration Form for Aupairs and AuPair Plus

NESSIES NANNY RECRUITMENT AGENCY

7 Barnston Close, Luton, Bedfordshire, LU2 9RZ England
Tel/Fax 01582 892895  Tel/01582 519270
E-Mail nessies@aupairs47.freeserve.co.uk

CLIENT REGISTRATION FORM FOR AUPAIRS AND AUPAIR PLUS

Name of Father........................................................

Name of Mother........................................................

Address

.....................................................................
Home Tel. No...............Fax No............Work No..................

Is yours a single parent household....................................

Fathers Nationality...............Age.......Religion..................

Mothers Nationality...............Age.......Religion..................

Fathers Occupation.....................................

Mothers Occupation.....................................

Number of children

Name.....................Sex..........Age.............

Are their any step children in your family Yes/No

If yes, do they live in your household................

Do any of your children take any medication/or have a medical

condition............................................................

YOUR FAMILY AND HOUSEHOLD

Does anyone smoke in your family Yes/No

Is English the main language spoken in your family Yes/No

Please briefly describe your House...................................

Driving Licence required Yes/No Do you have any pets Yes/No

Do you employ a cleaner Yes/No Accomodation Offered...................

Is your home near a Bus/Train Station.................................

Nearest Main Town.....................................................

Distance from nearest College.........................................

Days and times allowed to attend an EFL Course........................

WHAT YOU REQUIRE

Period of Engagement 3 months or less............6 months plus........

Your Requirement AuPair........AuPair Plus.......Male AuPair..........

Desired Commencing Date............Care of children...................

Simple cooking for children...............Do you require help with

with dusting, washing, ironing and hoovering..........................

Number of days work per week.............Which days...................

Number of work hours per day...........From AM.........PM.............

If flexible hours required, please give some shift examples

......................................................................
How many days off per week...................Which days...............

Pocket Money per week.................................................

ANY ADDITIONAL INFORMATION YOU REQUIRE OF YOUR AUPAIR

......................................................................
PLEASE SUPPLY ONE REFERENCE THAT WE MAY CONTACT

......................................................................
GENERAL INFORMATION

For Families who are considering employing an AuPair or an AuPair Plus.

NESSIES NANNY RECRUITMENT AGENCY also organizes English Language Classes for AuPairs to help them to improve their English. We also place Au Pairs in Europe.

On completion of this Registration Form, we will forward you our Terms of Business, also our Terms and Conditions for AuPairs.

Signed Date