Family Registration Form

First name*

Family name*

Email address*

Residential address*

Preferred phone number*

Alternative phone number

Number of adults in your family*

Ages and names of children*

Is this position:*

Live in

Live out

Is this position:*

Sole charge

Mother’s help

Preferred placement method:*

Pre-select

Here now

Either

Info on the difference between ‘pre-select’ and ‘here now’.

Total hours per week*

Weekly pocket money offered*

A $500 completion thank-you bonus is payable to au pairs staying 6 months or more. Do you agree to pay the completion bonus:*

Yes

Preferred au pair start date*

Minimum length of stay*

Note most au pairs commit to between 4 - 6 months, flexible

Job description (enter details here or attach a file below if you prefer)*

Including hours, duties and any relevant information regarding your family’s needs. Please be as detailed as possible as the au pair will view this information. Just enter "N/A" here if you’ve attached a file below

You may attach a file with Job description if you prefer

Private bedroom for au pair:*

Yes

Separate bathroom for au pair:*

Yes

Non-smoker preferred:*

Yes

Driver’s licence required:*

Yes

Driver’s licence type:*

Manual

Auto

Please ensure relevant insurances are in place for an au pair / nanny as this is the responsibility of the family

Location of home:*

City / suburban

Country / rural

Outback

Travel time to city*

Travel time to transport*

Travel time to beach*

Please describe any special facilities if any*

If you are located in a country or unusual location, please describe your area

Do you have any pets:*

Yes

Please describe your pets*

Is this information true and correct:*

Yes

I have read the terms & conditions and agree to pay the agency introduction fee on commencement of 'Here now' applicants or arrangement of 'Pre-select' applicants:*

Yes

How did you hear about our agency*

Do you have any other information you’d like to include

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