Name

Address (including State)

Telephone

email

Father’s job

Mothers job

Marital Status

Children’s names, age and gender

Is a baby expected?

What is your nationality?

Do any of the children have special needs?

Do any other persons live in your household?

Are any other languages spoken at home?

What date is the Mother’s Helper required?

How long is she needed for?

Is a driving license essential?

Is a car available off duty?

What are the main duties of your Mother’s helper?

Do you have any pets?

Will the Mother’s helper be left in sole charge of children?

Is your home in a city, town or countryside?

Where is the nearest public transport?

What social, recreational or church activities are available?

Please write a description of your home.

Please write a description of the Mother’s helper’s room.

Are you practicing Christians?

What is your place of Worship?

How regularly do you attend?

How would you describe your church?

How many hours per week do you require?

Upload a family photo if you are able.