Sur Name :
First Name :
Email :
Address :
City :
Country :
Fax :
Telephone :
Marital Status :	Single Married Divorced
Language spoken at home :
Do you or any other member of your family speak another language ?
Linmark Educational Services
Number of children :	None 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Details of children :
Father Occupation :
Mother Occupation :
Do either of you work ?	Nights Weekends Shift work
Please give details on all family members who live in your house :
Does any member of your family suffer with emotional or physical disability ? If yes please explain :
If divorced/separated, please describe how often children are away from the house ?
Family activities and hobbies :
Do you have pets if yes what ?
Aupair to start when ?
For how long ?
Have you employed an aupair or mothers help before ?
Do you employ a domestic cleaner, housekeeper ?
Does your family have any special dietary habits ? if yes then what ?
Will the aupair have her own bedroom/bathroom/tv ?
Your Aupair Requirements
Smoking :	Yes No
Would you consider a male aupair ?	Yes No
Would you pay part of the aupair's airfare ?	Yes No
Are you willing to have an aupair of another race ?	Yes No
Are you willing to have an aupair of another faith ?	Yes No
Must the aupair have a valid drivers license ?	Yes No
Preferred Aupair Nationality :
Job description(As accurate as possible) :
Is aupair sole charge ?	Yes No
How Often ?
Is she mothers help/assisting with the children and household dutie ?
What hours is she expected to work ?	30 35 40
Aupair will be paid an allowance of (Net) per week.(in your country’s denomination) ?	150 180 200
It is appropriate for families to pay tax which covers all the advantages given to workers during and after their employment. Payment in NZ$ 30 hours = $150.00 net per week - tax $29.24 per week = $179.25 gross 35 hours = $180.00 net per week - tax $35.10 per week = $215.10 gross 40 hours = $200.00 net per week - tax $39.00 per week = $239.25 gross IRD Employer tax deduction Form IR 345 For childrens outings: the aupair will need extra moneys to cover entertainments i.e movies, mcdonalds etc. Not paid out of Aupair's wages.
Is she free on weekends ? If not what days will she be free ?
Close To :	Beaches Shops Transport
Community profile :	Urban Suburban Rural
Aupair arrival airport :
Nearest major city :
Is public transport available to this city ?	Yes No
Please add anything you may want her to know about vacations, favorite meals, favorite activities that she can join in etc :
Will she be able to take courses e.g.. English, Red Cross, Childcare Course, Cooking, Household Courses etc ?
Name of Father :
Name of Mother :
I/WE understand, Agency fees will be              Yes No applicable, if the Agency successfully places an applicant with the Family : $400.00 plus GST up to 9 month - $500.00 plus GST up to 12 month. If the Applicant stays 3 month only you will be offered another candidate free of charge as long as the Agency is notified well before the present candidate departs.
I/WE certify that the information contained in this Application is true :	Yes No