Applicant - Details First Name:   Last Name: Email: Spouses Name (if applicable): Are you a single parent? Yes No Family Nationality: Address Street Address:   City: Postcode: State: Home Phone: Mobile Phone: Work Phone: Au Pair Requirements Preferred Starting Date: (dd/mm/yyyy)   How long do you need an Au-Pair for (3-10mths)? What is the minimum period you would accept? Please describe in detail the hours and the duties required?    Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday What salary are you offering e.g. $8/hr Based on how many hours? Would a male be acceptable? Yes No How many children do you have? What are their ages and sex? Do any of the children attend day care, pre school or school? If so details? Do any of your children have special needs? Details: What percentage of time would the Au-Pair be alone with the children on a weekly basis? Is the family vegetarian? Yes No Does anyone in the household smoke? Yes No Would you accept an Au Pair that smokes? Yes No What are the family’s hobbies and interest? Do you employ a regular cleaning person? Yes No If not, who is responsible for the cleaning in the house? Do you employ any other help around the house? Yes No Does your house have a dishwasher? Yes No Do you require the Au-Pair to iron children's clothes? Yes No Do you require the Au-Pair to iron you or your spouse’s clothes? Yes No Does the Au-Pair need to drive your car? Yes No What type of car does the Au Pair need to drive? (Sedan, 4WD, 7 Seater etc) Do you have a private bedroom for the Au-Pair? Yes No Do you have a private bathroom for the Au-Pair? Yes No If no - who will the Au Pair share a bathroom with? How many Au-Pairs/Nannies have you had in the past three years? Do you have any pets? - If so, please describe. Do you have any other facilities that might appeal to the Au-Pair? eg.TV in room, Pool, access to PC etc? Location of home: CBD, Metro, Suburban, Regional, Remote? How many minutes to walk to public transport? (Train or bus?) How many minutes travel time to city on public transport? How many minutes travel time to the nearest beach on public transport? Please share any comments you think will be helpful to us. Confirmation This information is true and correct: Date of Creation: 9/09/2010