First Name:
Last Name:
Email:
Spouse Name:
Single Parent:
Nationality:
Street1:
Street2:
Suburb:
State:
Post Code:
Country:
Home Phone:
Mobile Phone:
Work Phone:
Position Available:
Preferred Starting Date:
How Long For:
Minimum Period:
Details of role:
Morning Routine:
Day Routine:
Evening Routine:
Babysitting requirements:
Other duties:
Details Monday:
Details Tuesday:
Details Wednesday:
Details Thursday:
Details Friday:
Details Saturday:
Details Sunday:
Weekly / Hourly Salary:
Weekly Hours:
Male Acceptable:
How Many Children:
Children Details Age:
Children in Day Care:
Children with Special Needs:
Percentage of Work / Time With Children:
Is Family Vegetarian:
Smokers In House Hold:
Allow Au Pair to Smoke:
Family Interests:
Have Cleaning Person:
If not Cleaning Responsibility person:
Other Help:
Have Dishwasher:
Iron Childrens Clothes:
Iron Other Clothes:
Drive Car during work:
Type Of Car:
Private Bedroom:
Private Bathroom:
Share Bathroom With:
How Many Au Pairs / Nannies in the Past 3 Years:
Pet Details:
Other Facilities:
Home Location:
Distance To Transport:
Distance To City:
Distance To Beach:
Comments:
Terms and Conditions:I have read and understood the Terms and Conditions of El Viaje Au Pair and Nanny Placements.