For Au Pair families

Husband/Partners nationality
and religion:

Wife/Partners nationality
and religion:

Names, ages and sexes
of children:

Do any of the children have
special needs?

Is a new baby expected?

Family hobbies and interests:

Family pets:

Live in or daily:

Full or part time:

Will employee be required
to take sole charge?

Date required from:

Duration of stay:

Do you require a driver?

Manual/Auto:

Use of car when of duty:

Would you like a non-smoker?

Will employee accompany
you on family holidays?

Mornings:

Afternoons/Evenings:

Babysitting evenings per week:

Days off/Free time:

How many weeks per annum paid
holiday will the employee have?

What net salary is offered?

Describe employyes accommodation:
(own room/own bath/TV)

Describe your home:
(number of rooms, etc.)

Distance from home to town:

Local transport:

Please add any comments wich
may assist us in finding you a
suitable aplicant:

How did you hear about our agency?

Would you mind if we passed your
home number onto other nannies
so that they can contact your
nanny & make friends?

 Yes

 No

Please give the name and adress
of one person (outside the family)
to whom the agency can apply
for a personal reference:

I have read and accept the terms and conditions of business of “Litaupa ir Ko” and declare that the above details given are correct.*

Signed

* — necessary to fill