Title

Company

Address

City

State

Zip Code

Business Phone

Days and hours of work

Do you travel for work?

No Yes

If yes, how often?

What time do you leave for work?

Return from work?

Do you participate in any non-occupational work such as volunteering? If yes, please explain

Employment Verification Contact

Phone

Employment: Host Parent 2 Employment Information

Title

Company

Address

City

State

Zip Code

Business Phone

Days and hours of work

Do you travel for work?

No Yes

If yes, how often?

What time do you leave for work?

Return from work?

Do you participate in any non-occupational work such as volunteering? If yes, please explain

Employment Verification Contact

Phone

Family Member Information

Please list all members residing in your household:

Name

Relationship

Gender

Date of Birth

Name

Relationship

Gender

Date of Birth

Name

Relationship

Gender

Date of Birth

Name

Relationship

Gender

Date of Birth

Name

Relationship

Gender

Date of Birth

Name

Relationship

Gender

Date of Birth

Do any of your family members have a physical or emotional disability? If yes, please explain

If parents are divorced are there any special circumstances regarding any family members that would be necessary for our agency or the au pair to be aware of? If yes, please explain

Do you have any pets? If yes, please describe

Do any of you family members have any special dietary habits? If yes, please explain

Have any member of your family ever been convicted or arrested for any criminal offense? If yes, please explain

Have there been any incidents of domestic violence within your family? If yes, please explain

What is your religious affiliation?

How often are you involved in religious activities?

Do you expect the au pair to attend religious services with you?

Would you agree to host an au pair with religious beliefs different from your own?

Program Preference (select one)

Infant Care Standard au pair

Au Pair Preferences

Are you interested in a male or female au pair?

Does the au pair need to have a drivers license?

No Yes

Do you have a private bedroom for the au pair?

No Yes

How particular are you about houskeeping?

Very Somewhat Not at all

What light childcare related housekeeping duties do you expect the au pair to perform?

Will the au pair have the same heating/cooling system as the rest of the house?

No Yes

If no, please explain

Will the au pair be able to have full use of the kitchen

No Yes

If no, please explain

Have any family members ever visited a foreign country?

No Yes

If yes, which members and what countries?

Have you ever hosted an au pair before?

No Yes

If yes, from which country and their length of stay?

Please comment on your experience

How did you hear about the Au Pair Foundation?

Family Essay & Photos

Please attach a family essay detailing a profile of your family and community. This profile will be used by APF as an aid to find the most suitable au pair for your family. It will also be sent to the au pair once the match has been made. Please make sure the information provided is informative and accurate. Include details such as a description of your family activities, neighborhood, a typical week for you and what you would expect the au pair to do for your family and why you are interested in the au pair program. Please include at least 2 photos that show your entire family. Next to each photo, please descibe who it is and where the photo was taken.

Family Essay

Family Photo

Description

Family Photo

Description

Family Photo

Description

Digital Signature

By typing my name in the Host Parent 1 text box below, I certify that the information contained in this application is true.

Host Parent 1

Enter the code

Host Family Application

Emergency Contact

Employment: Host Parent 1 Employment Information

Employment: Host Parent 2 Employment Information

Family Member Information

Please list all members residing in your household:

Au Pair Preferences

Family Essay & Photos

Digital Signature