Larah Au Pairs - Au Pair Agency based in Woking, Surrey

Larah Au-Pairs
Employment Agency
21 Fenwick Close
Woking, Surrey
GU21 3BY

Tel:01932 341704
Fax:01483 740544
Email:info@larahaupairs.co.uk

Please complete and then press the submit button at the bottom of this page. You will also need to send a cheque for the sum of £30 to the address above. You will be required to accept our terms and conditions.
Date Au Pair Required:		Length of Employment:
FAMILY DETAILS
Family name:
Full address:
Home phone		Home fax
Email		Mobile
PARENT DETAILS
Mothers name:		Occupation:		Age range:
Mothers work No.		Nationality:
Fathers name:		Occupation:		Age range:
Fathers work No.		Nationality:
CHILD/REN DETAILS
Name of Child 1:		M F	D.O.B		Age:
Name of Child 2:		M F	D.O.B		Age:
Name of Child 3:		M F	D.O.B		Age:
Name of Child 4:		M F	D.O.B		Age:
Baby due?		(if yes, please put due date)
HOUSEHOLD DETAILS
Language spoken in household		Other languages spoken by family:
Religion:		Practicing: Y N
Interests/Hobbies:
Pets:	Dog Cat Other
Will Au Pair be required to assist with pets? Y N
ACCOMMODATION DETAILS
Location of House:		Type of House:
Number of Bedrooms:		Bathrooms:			Receptions:
Central Heating		Washing Machine			Dishwasher
Will Au Pair have own room?		Bathroom			TV
Nearest Airport?		Train?
Nearest Bus?
Nearest Town?		Language School?
AU PAIR DETAILS
Do you require an au-pair or mothers help?
Have you had an au-pair before? Y N				Would you accept male/female? Male Female

Is smoking permitted in the house? Y N				Can the au-pair smoke? Y N

What hours will the au-pair work?				Do you require a driver? Y N

Will you provide a bike or car for the au-pair? Bike Car				Can the au-pair have own use of car? Y N

Are there any members of the family with special needs? Y N
Describe duties required:
What days will au-pair have off?		Mon Tues Wed Thur Fri Sat Sun
No of nights babysitting required?		0 1 2
How much pocket money(weekly)?
Petrol each week?			Total weekly hours?
Will you collect the au-pair on their arrival or pay for alternative transport? Y N
OTHER DETAILS
How did you hear about our agency?
Please supply any further information that you consider necessary for us to find you the right au-pair.

Please state any risk to the health and or safety of the au-pair whilst in your employ* (Examples of health risk would include infectious diseases and the like, while risk to safety would include home under construction ie. risk of injury) * DTI required

TERMS & CONDITIONS ACCEPTANCE
I/We agree to the Terms and Conditions of Larah AuPairs (Please note that the form will not submit unless you agree to the Terms and Conditions)

Larah Au-Pairs - Employment Agency, 21 Fenwick Close, Woking, Surrey, GU21 3BY