Hungarianaupairagency.com

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To be completed by families looking for an au pair ON-LINE APPLICATION Please read the "Family Fact Sheet" and the "Business Terms & Conditions" pages before completing this form, Primary Applicant Use "tab" and "shift-tab" to move from field to field.  Title MsMrsMr  First Name  Surname Marital status  Age  Occupation Smoker SelectNoYesOccasionally  Religion Practising SelectYesNo Present nationality Previous nationality Secondary Applicant  Title MsMrsMr  First Name  Surname  Marital status Age  Occupation Smoker SelectNoYesOccasionally Religion Practising SelectNoYes Present nationality Previous nationality Further Information House number and street Town County Post code Country Home number Work number Mobile number Skype Email Address Household Language spoken at home Special dietary requirements Number of adults 1234 Number of children 12345 1st child (Name, sex, D.O.B.) 2nd child (Name, sex, D.O.B.) 3rd child (Name, sex, D.O.B.) 4th child (Name, sex, D.O.B.) 5th child (Name, sex, D.O.B.) Baby due SelectYesNo If so, when SelectN/A20012002SelectN/AJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Does any member of household have special needs SelectYesNo If so, please specify Will Au Pair need to assist SelectN/AYesNo Pets Will help be required with the pets SelectN/AYesNo Have you had an Au Pair before SelectN/AYesNo Is there any other domestic help SelectN/A2nd Au PairCleanerGardenerOther Type of family accommodation SelectHouseFlatBungalowFarmhouse Bedrooms Select123456More Receptions Select1234More Bathrooms Select1234More Nearest BR or underground and distance Family hobbies and interests Please state any useful information or special requests Requirements Date Au Pair required For how long Male or female preferred SelectFemaleMaleBothEither Minimum age required SelectAny Age1718192021222324252627 Smoker accepted SelectNoYesOutside OnlyAway From Home Only What level of English is required SelectNoneBasicConversantGood Is a driving license required SelectNoYes How often will Au Pair be required to drive SelectN/ARegularlyOccasionally Will Au Pair be allowed to use vehicle for own use SelectN/ANoYesTo Be Discussed If so, will petrol be provided SelectNoYes Working Conditions *Please state any risk to the health and or safety of the Au Pair whist in your employ.  (Examples of health risk would include infectious diseases and the like, while risk to safety would include home under construction i.e. risk of injury.)   *DTI required question.    AM, PM,Total  (e.g. 10.00-12.00, 14.30-17.00, 4.5)   Monday Tuesday Wednesday Thursday Friday Total hours Duties Will Au Pair have sole charge of children or babies SelectNeverOccasionallyAlwaysSchool Holidays Only If so, please state hours Will any weekend work be required SelectNoYesOccasionally Which two evenings will baby-sitting be required Select two if applicableMondayTuesdayWednesdayThursdayFridaySaturdaySundayTo be discussedOccasionally Days off  Holidays allowed SelectAfter 6 monthsChristmasEasterDuring Family HolidaysTo be Discussed How long Select1 Week for every 6 months service2 Weeks3 Weeks4 WeeksTo Be Discussed Holiday pay SelectHalf PayFull Pay Bank holidays allowed SelectYesNo How often will Au Pair be permitted to attend English classes SelectAnytimeOnce a weekTwice a weekThree times a weekDaily When during the day  SelectAnytimeMorningsAfternoonEvenings Approximate distance to classes Select0-2 miles2-4 miles4-8 milesOver 8 Bus Pass provided SelectNoYes Times of classes Approximate cost Will family contribute to costs SelectAfter 6 monthsYesNo If so, how much SelectFull feesHalf feesOnly as a loan Will Au Pair have their own room SelectYesNo Details of room contents Which day will Au Pair regularly be paid (weekly pay) SelectMondayTuesdayWednesdayThursdayFridaySaturdaySunday Amount of pocket money (pay) Select£70£75£80£82.50£85£87.50£90£92.50£95£100£110£120£130£140£150£160£170£180£190£200 How did you hear of the Hungarian Au Pair Agency   SelectRecomendation by a friendI am a repeat clientInternet searchRadio JackieRecomendation by an Au PairYellow PagesThomson DirectoryGoogle Ad-WordNewspaper advertRecomended by the Hungarian EmbassyOther Declaration I have read, fully understand and accept theTerms and Conditions of the Hungarian  Au Pair Agency and declare that the above  information provided  by me is true.  By submitting this document,  I agree to the Agency   Terms and Conditions and agree to pay the full placement fee upon the engagement of an Au Pair.           Signature (Family name): Date: Please press to send completed form. Press to clear all form entries. Web site designed by: Steve Tuba stevetuba1@aol.com Hungarian Au Pair Agency © 2001 - 2007