INTERVIEWER'S REPORT

SECTION I: GENERAL

Name of Applicant:
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Nationality:
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What is the applicant’s family’s opinion of coming to the U.S. as an au pair?:

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Do the applicant’s friends support the idea of coming to the U.S. as an au pair?:

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Does the applicant socially drink wine/ beer etc? sometimes ; never

Does the applicant smoke cigarettes? Yes ; No

Inform the applicant that 99% of American families will not accept a smoker so s/he must quit smoking unless in a rare instance where the au pair and host
family sign a written agreement that it’s OK to smoke during the program year.

What is applicant’s father’s occupation?:

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What is applicant’s mother’s occupation?:

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Has applicant spent any time away from home in the past? (give circumstances):

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What are the applicant’s plans after s/he returns home from the U.S.?
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SECTION II: EDUCATION

What level of education has the applicant completed?:

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SECTION III: EMPLOYMENT

What was his/her favorite job involving children? Why?:

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 SECTION IV: PERSONAL AU PAIR PROFILE

Why does the applicant want to be an au pair in the U.S.?:

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What skills does applicant possess that are important to succeed as an au pair in the U.S.? Why would the applicant be a
good au pair? :
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Does the applicant feel a 45-hour work week is feasible?:

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How does applicant feel about adjusting to the new culture and surroundings?
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SECTION V: EXPERIENCE AND LOGIC

Two children are fighting over a toy. How would you handle this situation?:
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What do you do when bedtime is 8:00 and the child refuses to go to bed?
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SECTION VI: CHILDCARE KNOWLEDGE

What are appropriate activities to do with:

Infants 3-12 months? :

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1-2 years? :
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2-5 years? :
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6 to 10 years? :
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Does the applicant have any questions for Agent Au Pair?

Interviewers Name:
'DQLHOD%RUUDH]
Date:


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 Driving Experience

How many years have you been driving?

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How long have you had your drivers license?

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Do you have your own car?

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How many hours per week are you currently driving?

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Have you been driving with children in the car before? If yes, please explain.
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How comfortable are you behind the wheel and do you think you will need driving instructions in the US?
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Have you ever been held responsible in an auto accident? Please explain.
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Interviewers Name:
'DQLHOD%RUUDH]

Date:


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 SUMMARY INTERVIEWER'S REPORT

Name of Applicant: 0DGHODLQH'DULDQ3L]D0XULOOR

ENGLISH SKILLS
Excellent Very Good Good Fair Basic Beginner
Comprehension [
Spoken [
Written [
(Excellent means fluent or bi-lingual capacity; very good means understands and speaks most words; good means
understands and speaks well; fair means understands and speaks a little bit; basic means very basic level – only can
understand/say a few things; Beginner means does not speak or understand much – has very low English skill level).

CHILDCARE EXPERIENCE

Do you feel the au pair has excellent childcare knowledge and enough experience to successfully take care of children?:
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Please state why you feel applicant would be good au pair:
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Would you feel totally comfortable entrusting your young child to the care of this applicant? [ Yes No
If no, why not?

OVERALL RATING
Please provide your impressions of the applicant’s demeanour, personality, character and appropriateness for becoming an
au pair in America for one year with Agent Au Pair.

Excellent Very Good Good Fair Poor

Self –Confidence [
Grooming [
Attitude [
Manners [
Communication Skills [
Desire to improve English [
Apparent Conscientiousness [
Friendliness [
Flexibility/ Adaptability [
Poise / Social Skills [
Maturity [
Apparent Values/ Judgement [
Intelligence [
Experience with Children [
Motivation to be a good au pair [
Love of Children [

Interviewers Name: 'DQLHOD%RUUDH]

Date: 
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