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GreatAuPair Personal Reference Form

GreatAuPair is a full-service au pair agency that has been providing affordable live-in childcare to
American families through carefully screened international au pairs since 2001. As part of our
screening process, we require that each au pair submit references confirming her/his suitability to
care for children up to 45 hours per week.

In addition to completing this form, a GreatAuPair representative will be contacting you to verify
your reference. If you do not speak English, please complete the form in your native language.
Thank you.

Name of applicant au pair

Name: Marina Ivanova

Reference Information

Name: Viktoriya Petrova


Contact telephone: +380931234567
Best time to reach: anytime
Email address: petrova@gmail.com
Street address: 10 Lenina street, flat 15
City, Province, Postal Code, Country: Chernihiv, 14005, Ukraine

Reference Questions

Please state how you know this candidate.

English teacher
How long have you known this candidate ? 15 years

How would you describe this candidate’s ability to cooperate and work with others?
Marina is a very sociable, communicative, open person who can easily converge and cooperate
with other people.

What are this candidate’s strongest qualities?


She is very optimistic and has resistance to stress. She is very sincere and hardworking person.

Do you know of any reason why this candidate should not be accepted into the GreatAuPair
program to care for children for a year in the U.S.A. while living with an American family?
No
Please provide any additional comments you think would be helpful in evaluating this candidate’s
application.
Marina is perfect applicant for this program because she is very responsible and caring person.
She has an excellent ability to bring up children. She loves taking care of them.

A prospective family may contact you to discuss your reference. Do you feel comfortable
speaking English? Yes No

Printed name Viktoriya Petrova

Signature of reference Date 13/06/2014

For official use only:

Reference verified by: Rep ID:

Method of verification: Date:

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