DEMI PAIR / AU PAIR HOST FAMILY APPLICATION FORM Please complete in BLOCK CAPITALS IN BLACK INK GENERAL INFORMATION
Please describe your home:
Family Name: Mother’s Given Name: Father’s Given Name: Address:
Preferred Start Date: For how long do you require the services of the Demi Pair/Au Pair?
Suburb:
Months
Post Code:
Do you require the Demi Pair/Au Pair to drive?
Tel. (Home):
Please describe what you consider to be the main role of your Demi Pair/ Au Pair:
Tel. (Work):
YES
NO
Tel. (Mobile): Email: DETAILS OF FAMILY Mother’s Nationality: Occupation:
Please give any other information that you think may be useful:
Working Hours: Father’s Nationality: Occupation: Working Hours: Emergency Contact name: Tel. : DETAILS OF CHILDREN Please attach the following documents:
Name: D.O.B:
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AGE:
MALE
FEMALE
FAMILY PHOTOGRAPH (may be sent by email)
Name: D.O.B:
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AGE:
MALE
FEMALE
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AGE:
MALE
FEMALE
Name: D.O.B:
Please tick the option that best suits your family: \
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AGE:
MALE
FEMALE
OPTION ONE: 15 hours per week & one night babysitting $60 OPTION TWO: 20 hours per week & 2 nights babysitting for $85
Name: D.O.B:
COPY OF DOMESTIC WORKER”S COMPENSATION POLICY POLICE CLEARANCE (COMPULSORY FOR ALL FAMILY MEMBERS OVER 18 YEARS)
Name: D.O.B:
LETTER OF INTRODUCTION (may be sent by email)
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AGE:
MALE
FEMALE
Please send your application along with the above documents to
Do your children require any special medical attention? If yes specify below
YES
NO
Do you have a separate bedroom for the Demi Pair/Au Pair? NO YES Do you have any pets? If yes specify below
YES
Please describe your family’s favourite activities/hobbies:
OPTION THREE: 30 hours work and three nights babysitting $130
NO
PHOENIX ACADEMY PO BOX 256, Leederville 6903 WESTERN AUSTRALIA Tel: (08) 9227 5538 Fax: (08) 9227 5540 Mobile: 0438060763 (Ann) Email: alyall@phoenixacademy.com.au Web: www.phoenixacademy.com.au