Au-Pair South London
Au-Pair South London Au-Pair South London

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Our Contact Details

Companion For The Elderly Form

Please complete the application form below to enable us to match the right candidate for you. If you do not have a reply from us within 48 hours please give us a call on 01932 341704 to confirm we have received your completed form. We have compatibility issues with Yahoo and AOL email addresses so if possible please use an alternate email address to Yahoo or AOL. Fields marked with * are required but please look to complete as much of the form below as possible.

Date required *

Name of contact person *

Contact telephone number *

Email address *

Relationship to client *

Description of accommodation *

Have they had a companion before? *

Are there any other employees? *


Name *

Contact telephone number *

Age *

Sex *

Nearest town *

Nearest airport *

Nationality *

Religion *

Main language spoken *

Other languages spoken *

Type of residence *

Any pets? *

Would you accept a smoker? *

Do you require a driver? *


Describe physical and mental condition *

Require assistance to walk? *

Any special diet? *

If you answered yes to the above question, please specify

Any other information?

Duties required (Tick all that apply) *

Help to get up and going to bedBathing and showeringGeneral houseworkLaundryAssisting to toiletShoppingOther

If you ticked other, please specify


How many hours per day required? *

Weekends off? *

Weekly net salary *



I / we agree to the terms and conditions