Family Apprication Form
Your childcare needs Live In Aupair Live In Nanny
PARENTS: Please indicate name and surname
Mother Name Father Name
Address Suburb & postcode
City State
Mother email Father email
Age of Mother Age of Father
Religion of Mother Religion of Father
Mother mobile Father mobile
Home phone (incl. area code)
Mother work hours
(indicate if stay/work from home)
CHILDREN: Type in date of birth DD/MM/YYY
Name Age Date of Birth Sex
Name Age Date of Birth Sex
Name Age Date of Birth Sex
Name Age Date of Birth Sex
Name Age Date of Birth Sex
Please describe the locality of your home: rural, inner suburb, city etc. Please also include information about proximity of public transport.
Period required: Aupair min 6mnth max 10mnth
Start date required Hours pw required
Please detail the position duties
Tick days required
Mon Tues Wed Thurs Frid Sat Sun
Please detail the hours required generally each day - especially weekend hours if applicable
Remuneration net
Additional Benefits: We will contribute towards the cost of travel to Australia and our home OR we will pay an end of stay bonus.
Please provide a brief description of the accomodation provided.
Briefly describe the personality of a childminder that would fit with your family
Please tick appropriate boxes relating to your childminder requirements
Studious Non Smoker Male Female Sporty
Artistic Musical Outgoing Driver
Please provide a description of your children -- their personalities, needs, interests, including if any of them have a serious handicap, allergies or learning disabilities that may affect their childminding needs.
MORE ABOUT THE FAMILY:
Do any of the adults in the home smoke?
Other assistance in the home? Detail
Describe your family lifestyle - ie: outdoors, intellectual etc
Please select the following: only applicable if you require a driver - Will you provide the following?
Manual car Auto car Private use allowed
Do you have pets?, please detail. Is the childminder required to care for the pets?
Family Rules: Please tick the appropriate boxes
Friend visit Use of family TV Own TV provided Internet Access
Family will pay for local calls? Childminder to pay for o/seas or STD calls
Any other special rules? Please detail
Verify text *
     Registration fee of AU$99 has been paid
In addition the above form, we request the following:
  1. Please write a letter to your prospective aupair giving more details about your family and lifestyle. Please also include a description of your area where you live and the community life.
  2. Please include some photos of your family. This could be photos of yourselves and the children, your house, the room the aupair will have etc
  3. Please provide 1 written reference via email from someone who is not related to the family.
SUBMISSION OF THIS APPLICATION INDICATES:
  1. THAT I/WE HAVE READ AND AGREED TO THE TERMS AND CONDITIONS FOR PLACEMENT OF A NANNY/AUPAIR OR MOM'S HELP.
  2. WE ARE FAMILIAR AND AGREE TO ABIDE BY ALL PROGRAMME GUIDELINES AND CONDITIONS, IN PARTICULAR THOSE REGARDING: THE NUMBER AND DISTRIBUTION OF WORKING HOURS, DUTIES, REMUNERATION, FREE TIME, HOLIDAYS, INSURANCE AND TERMINATION OF THE PLACEMENT.
  3. WE UNDERSTAND AND AGREE THAT JCR CANNOT BE HELD RESPONSIBLE OR LIABLE FOR DAMAGE IN THE RESIDENCE OF THE HOST FAMILY OR WHILST UNDER THE RESPONSIBLITY OF THE HOST FAMILY, THAT MAY HAVE BEEN CAUSED BY THE NANNY, AUPAIR OR MOM'S HELP.
  4. WE CONFIRM THAT WE HAVE ANSWERED ALL QUESTIONS HONESTLY AND THAT ALL INFORMATION IN OUR APPLICATION ( INCLUDING DESCRIPTION OF DUTIES) IS TRUE. WE DECLARE THAT WE ARE WELL INFORMED OF THE REQUIREMENTS TO HOST A CHILDMINDER.