Country wide au pairs and Au pairs 4 Ireland
14 Marshallstown Road, Downpatrick,
 Co. Down BT30 8AH, Northern Ireland, 
Aupairs2ireland@ireland.com
Tel: 04844 61 51 06
AU PAIR PLACEMENT FOR DUBLIN          PLACEMENT FOR COUNTRY 
AND COUNTY DUBLIN                                 IRELAND AND HORSE JOBS

______________________________________________

FAMILY QUESTIONNAIRE
100% Au Pair

Family name: 				                           
Address:                                        	
						
Telephone No:                       	  	 Mobile:   
Fax:   			  			 E-mail:
Web page:		
Mother’s name:                        		 Occupation:   
Does Mother work:                  		 Full/Part Time:  
Religion:		
Away over night:  	
Father’s name:            		  	 Occupation:		  
Parent’s age 					 (20`s/30`s/40`s/50`s)   
Single parent family:

When do you need an au pair? 

For what length of time:   	3/6months 		            6/9months  	                                        9/12months			 1year plus   
Do you require a driver:                		 If yes, essential/desirable 
If insurable, will the au pair be permitted some/no use of car?
Au Pair age group: 				Nationality preferred: 
Would you accept an au pair that smokes? 
Would you accept a restricted smoker:  		   (smokes away from children or outside only?) 
Would you accept an au pair who is vegetarian?
Where did you get the name of this agency?
Are you registered with another agency?  

From the guidelines given on page 1, how much pocket money will the au pair receive each week?

Standard Au Pair:                         Au Pair +: 
Mother’s help:                               Other:
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CHILDCARE AND ASSOCIATED DUTIES:

How many children in the family:            
New baby expected:
Name of children:                  Sex:               Age:
1.  	 
2. 	
3.  
4.  
5.
6.

Do any of the children suffer from any physical or mental disability which the au pair should know about? 

Do you have any other adult family members living in the home (Grandparents etc.)? 

Which of the following daily household chores would you expect the au pair to perform?

Tidying and vacuuming of:
Children’s play area:                   Children’s Bedroom:     
Children’s bathroom:                   Own bedroom:  
Family Kitchen:                            Family living rooms:  

Would the au pair be expected to:-
Cook for herself and the children:    	 Sometimes:             Always: 
Cook for the whole family:               	 Sometimes: 		 Always:

During the daytime would the au pair be expected to?
Take sole charge of the children some/most of the time:  
Take sole charge of children overnight:  

If both parents work, perhaps you would like to elaborate on the hours the au pair will be left in sole charge of the children: 

How many nights babysitting will be required (Minimum per week): 
Will the au pair be expected to baby sit on the same nights each week or is this flexible:
Will the au pair get the same days off each week or is this flexible:  
Will the au pair be able to attend language classes locally? 
Do any members of the household speak a foreign language and if so please outline: 
Do you have any domestic pets? 
Dog/s:             Cat/s:                   Guinea pigs:             Rabbit/s:               Other:

Will au pair be expected to feed and care for these animals?
Sometimes:                Often:                    Never:

Do any of the children have an interest in a particular sport/s? 
Swimming- Football- Tennis- Riding- Dancing- Sailing- other:

Do any of the children have a special interest in Music or the arts? 
Music:                        What instrument: 

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The Family Home and environment

Is your home in the:       Countryside:       Town:      City:

Is your house 	semi-detached/	 Detached/ 	Bungalow/	 Farmhouse/
Part of a farm/	 House & Garden in the country/	 other:

If in the country, how close is your nearest neighbor?

How many bedrooms do you have:           Bathrooms? 
:
Do you have any of the following domestic appliances?
Dishwasher:      Washing machine:      Dryer:      Rotary/Press iron:  
Do you have any other domestic help?

How close is your home to:  
Nearest local bus:                        Mainline bus/train: 
Nearest local shop:                      Nearest local pub/restaurant:
Nearest sport center:                   Nearest cinema: 
Do you have a bicycle which the au pair could use? 
Will the au pair have?
Own/shared Bathroom: 			Own shared TV. Access: 
(It is compulsory that the au pair has own bedroom in all cases)
Accommodation in any other part of the property other than the main house: (Flat over stables, annex etc.):
With separate accommodation, will the au pair be expected to share with someone else and if so, please explain their position within the family set up?

Forms will not be accepted without deposit, all fees must be paid before au pair placement.

On a separate piece of paper, please write a short "Dear Au pair" letter outlining some personal information about your family and their needs and what they would expect from an au pair coming to live in your family, anything you feel might help an applicant form a picture in their mind of your family, your home and your needs.   If you have a photograph of your family this also helps.

Please send a family reference from police/school/ priest etc. as are placing these girls in your family in good faith, we need to have some background information to verify you are who you say.  There is no offence meant by this.  You would expect the same if it was your daughter traveling abroad as an au pair with this agency.

Please complete and Sign.
The above completed family questionnaire represents a true and accurate picture of our family and home at this time, and outlines the conditions and duties expected of any au pair supplied through the Ann Collins Au pair Agency in this family.   I agree to engage the services of Ann Collins Au pair Agency in finding a suitable au pair for our family.
                  
Signed: ___________________ Date___________________

If you have other requirements, regarding help with the farm work, house or grounds maintenance, care taking or any other duties not covered in the above, please supply extra information in writing to cover same.

Should you have any more details that you think would be helpful to the au pair, please feel free to add to your application.

Please write your Dear Au pair letter below.

Dear Au Pair,