Au Pair Reference

Please type or print in dark ink. Completed references should be sent directly to the EurAupair program office/representative.

Siraporn Khunsamitpanya TL4009

Name of Applicant:____________________________________________________ ID Number: ______________________

Reference Information:
Wilai Sangtong 09840881540
Name:_____________________________________________________ Phone Number: ________________________
Watdontong Pracharatbamrung school , 87/1 village No. 2 5.00 PM
Address:___________________________________________________ Best Time to Call:______________________
Thathan Sub district , Phanomsarakham District, Chachoengsao , 24120
___________________________________________________ Do you speak English? ☐ Yes ☐
✔ No

Maewi.maelai@Gmail.com
Email Address:__________________________________________________________________________________________
3 years
How many years have you known the applicant?_______________________________________________________________
volunteer teacher
Please describe how you know the applicant (e.g. babysitter, employee, volunteer, friend, etc.):__________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

The applicant has applied for participation in the EurAupair Intercultural Child Care Program. EurAupair is an international
exchange organization dedicated to fostering cultural enrichment and intercultural understanding through youth exchange
programs. If accepted, the applicant will spend a year living with an American host family, participating directly in their home
life, providing child care assistance (45 hours each week), and attending a U.S. post-secondary educational institution. In order
for EurAupair to better evaluate the applicant’s eligibility for the exchange experience we would appreciate your opinion on the
following:

1. From your knowledge of the applicant, please rate her/him in the following areas:
Ex = Excellent, VG = Very Good, Gd = Good, Fr = Fair, Pr = Poor, or leave blank if unknown.

Ex VG Gd Fr Pr Ex VG Gd Fr Pr
Overall Attitude ☐ ☐ ✔ ☐ ☐ ☐ Composure ☐ ☐✔ ☐ ☐ ☐
Overall Personality ☐ ☐
✔ ☐ ☐ ☐ Maturity ☐ ☐
✔ ☐ ☐ ☐
Attitude Towards Child(ren) ☐ ☐
✔ ☐ ☐ ☐ Independence ☐ ☐
✔ ☐ ☐ ☐
Ability to Entertain Child(ren) ☐ ☐
✔ ☐ ☐ ☐ Articulation ☐ ☐
✔ ☐ ☐ ☐
Ability to Relate to Child(ren) ☐
✔ ☐ ☐ ☐ ☐ Humility ☐ ☐
✔ ☐ ☐ ☐
Ability to Relate to Adults ☐ ☐
✔ ☐ ☐ ☐ Sensitivity ☐ ☐ ☐
✔ ☐ ☐
Ability to Follow Preset Guidelines ☐ ☐
✔
☐ ☐ ☐ Patience ☐ ☐
✔ ☐ ☐ ☐
Academic Skills ☐ ☐
✔ ☐ ☐ ☐ Honesty ☐ ☐
✔ ☐ ☐ ☐
2. Please indicate the responsibilities with which, in your opinion, the applicant could be entrusted (if unknown, mark n/a):

Yes No N/A Yes No N/A

☐
✔
☐ ☐ Child(ren)’s Meal Preparation ☐ ☐
✔ ☐ Drive Child(ren)
☐ ☐
✔ ☐ Baths for Child(ren) ☐ ☐
✔ ☐ Supervise Child(ren)’s chores
☐ ☐
✔ ☐ Child(ren)’s Laundry ☐
✔ ☐ ☐ Plan Child(ren)’s Activities
☐
✔
☐ ☐ Light Housekeeping ☐
✔
☐ ☐ Care of Infant(s) (older than 3 months)
☐ ☐
✔ ☐ Care for Sick Child(ren) ☐
✔ ☐ ☐ Lift/Carry Child(ren)
☐ ☐
✔ ☐ Mentally Handicapped Child ☐ ☐
✔ ☐ Physically Handicapped Child
☐ ☐
✔ ☐ Care for Twins ☐ ☐
✔ ☐ Care of Multiple Children/Different Ages
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 3. Has the applicant taken care of your child(ren)? ☐ Yes ☐
✔ No OR child(ren) under your care ☐
✔ Yes ☐ No

Start End
Dates the applicant cared for the child(ren )(month/year): Mar 4, 2018 May 11 , 2018
___________/____________ Sep 8 , 2018 Sep 29, 2018
____________/____________
Age(s) of child(ren) the applicant cared for: 2 - 3 years old
________________________ ________________________
Mon- Friday for 3 months except Public holidays
How often does/did the applicant care for the child(ren)? ____________________________________________________
Delelovping and improving the language skill for children
List applicant’s duties/responsibilities:___________________________________________________________________
__________________________________________________________________________________________________
feeding them food and snack , tell the stories , singing and took them to snap and assit the teacher in the preparation activities

How many total hours did the applicant care for the child(ren)?_______________________________________________
450 hours

none
How many hours did the applicant care for children under two years of age, if applicable?_________________________

4. Do you feel perfectly comfortable recommending the applicant to a prospective host family, understanding that she/he
will spend a year living with the family and caring for their child(ren)? ☐
✔ Yes ☐ No

Additional Comments/Observations:_____________________________________________________________________
Yes , because she is patient , calm, kind and responsible person , adaptable person
__________________________________________________________________________________________________
and be able belong live with other and pay attention to children
__________________________________________________________________________________________________
__________________________________________________________________________________________________

5. To your knowledge has the applicant ever been arrested or shown any socially unacceptable behavior? ☐ Yes ☐
✔ No

If yes, please explain:________________________________________________________________________________

6. To your knowledge has the applicant ever abused alcohol, and/or used illegal drugs or other controlled substances? ☐ Yes ☐
✔ No

If yes, please explain:________________________________________________________________________________

7. To your knowledge has the applicant had any psychological or emotional problems? ☐ Yes ☐
✔ No

If yes, please explain:________________________________________________________________________________

8. In your opinion, what are the applicant’s strongest qualities?__________________________________________________

__________________________________________________________________________________________________
She has learned abou children's behaviors , how to handle handle children in many situations
__________________________________________________________________________________________________
communicate with children and make children feel comfortable when stay with her.
__________________________________________________________________________________________________

1/10/2022
Signature:____________________________________________________________ Date:_____________________________

For Office Use Only

Verified By: __________________________________________________________ Date:____________________________

Comments:_____________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

For Host Family Applicants: If this reference is a translation to English, from referee’s language, please note that it was not
made by a professional translator.

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