Please tick and/or complete the fields relevant and/or applicable:

Father's Name:
ID Number of Father:
Mother's Name:
ID Number of Mother:
Type of Caregiver Required:
  
Physical Address:
Postal Address:
Telephone Number:

Mobile Number:
E-mail Address:
Age of Child 1:

Sex of Child 1:
Age of Child 2:

Sex of Child 2:
Age of Child 3:

Sex of Child 3:
Age of Child 4:

Sex of Child 4:
Family Religion:
Home Language:
Au Pair to commence work on:
Please complete the following as accurately as possible:

What would your au pair's duties and responsibilities consist of?
Please indicate which of the following you would like your au pair to do:
Cooking Light household chores for the whole family Various errands for the family
Transporting of children Light household chores relating to the children

What would your au pair's hours consist of?
Which days would you need your au pair to work?
Would you require your au pair to babysit after hours?
Would she receive extra remuneration for babysitting?
What would your au pair's remuneration consist of?
Would your au pair need her own car?
Are you able to supply your au pair with a car?
What sort of person are you looking for?
Please state if there are any other requirements that you may have regarding your au pair?
(Age preference, language preference etc.)
Would your au pair receive any other benefits?
(Petrol allowance, car, accommodation, etc.):
If yes, what benefits?
  

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