Au Pair Family Application Form

Hello Dear Au Pair Family! Thank you for your phone call and your interest in welcoming an Au Pair.

PERSONAL DETAILS

Title *

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First Name *

Surname *

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Home Tel: *

Mobile Tel: *

Preferred Tel

Home
Mobile

Email *

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Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Nearest Bus Route

Nearest Tube Station

ABOUT YOUR HOME

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Will the Au Pair have his/her room? This is essential! *

Will the Au Pair have his/her bathroom? *

Private
Shared

Do you have Internet access which the Au Pair can use? *

Is there a quiet study place with a desk available for the Au Pair to use? *

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It is essential that the Au Pair has her own room! What type of room(s) is available the Au Pair? *

Single Bed
Twin Bed
Double Bed
Triple Bed
King Bed

Bedroom Furnishings *

Desk
Chair
Table Lamp
Bedside Lamp
Cupboard
Chest of drawers
Wooden Floor
Carpeted Floor
Fridge
Freezer
Shelves
Other

Other furnishings *

ABOUT YOUR HOUSEHOLD

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How many children live in the household ? *

How many Adults live in the household ? *

Child_1

Name (First Child)

Gender

Male
Female

Age

Child_2

Name (Second Child)

Gender

Male
Female

Age

Child_3

Name (Third Child)

Gender

Male
Female

Age

Child_4

Name (Fourth Child)

Gender

Male
Female

Age

Child_5

Name (Fifth Child)

Gender

Male
Female

Age

As you have more than five children provide the rest of the details here. *

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Do the children attend school and/or nursery? *

How far is the school or nursery from your home? *

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Does the family live in a *

house?
flat?

How many rooms does it consist of? *

How many bathrooms are included? *

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Distance from a shopping centre

Name of the shopping centre

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Distance from an educational institution where appropriate courses are available.

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Occupation of the Host

Occupation of the host’s spouse

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The host employs the following domestic staff in the home

The language normally spoken in the house is *

English
French
Spanish
Portuguese
Other

Other language(s) *

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Have you ever had an Au Pair before? *

Name

Phone

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Are you vegetarian?

Would you accept meat eaters?

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Do you or anyone on your household smoke? *

Do you allow smoking? *

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Do you have any pets? *

Other Pets *

Cat
Dog
Other

Please specify other pets and/or tell us how many pets you have

ABOUT THE AU PAIR

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Language the Au Pair should speak? *

English
French
Spanish
Portuguese
Other

Other language(s) *

Do you prefer a male or female Au Pair? *

Male
Female
No Preference

What will the Au Pair be required to do? *

Ironing Children’s clothes
Play dates
Do Children’s laundry
Bath and dress
Light cooking/Snacks
Light House cleaning
Shopping/Run errands
Homework/supervise
School Run (drop and/or pick up)
Keep house tidy
Drop at extra-curriculum activities
Other

Please specify other *

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When will the Au Pair's starting date be?

For how long?

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Would you consider offering the Au Pair English courses? *

Yes
No
Maybe

Would you travel with the Au Pair during your holidays? *

Yes
No
Maybe

REFERENCE

To complete your application to become an Au Pair Family with MPA Coaching, please provide us with 2 references we will be able to contact.

Referee 1

Referee 1 Full Name *

Referee 1 Mobile Number *

Referee 1 Home Number

Referee 1 Email Address *

Address Referee 1 *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Referer 2

Referee 2 Full Name *

Referee 2 Mobile Number *

Referee 2 Home Number

Referee 2 Email Address *

Address Referee 2 *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

DOCUMENTS TO PROVIDE WITH YOUR APPLICATION

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Pictures/Photographs of your family and home (up to 5 pictures)

Click or drag files to this area to upload. You can upload up to 5 files.

Letter addressed to the Au Pair

Click or drag a file to this area to upload.

Daily schedule/routine of tasks and duties you will require from the Au Pair

Click or drag a file to this area to upload.

DECLARATION

By submitting this form I confirm that the information supplied by me on this form is true and correct. I fully understand that further/additional information may be requested at any point by MPA Au Pair. *

Full Name *

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How did you find out about MPA Coaching?

Social Media
Word of Mouth

On which Social Media?

Facebook
Twitter
Instagram
LinkedIn
Google
TikTok