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:

Reference Information

Name:
Contact telephone:
Best time to reach:
Email address:
Street address:
City, Province, Postal Code, Country:

Reference Questions

Please state how you know this candidate.

How long have you known this candidate ?

How would you describe this candidate’s ability to cooperate and work with others?

What are this candidate’s strongest qualities?

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?
Please provide any additional comments you think would be helpful in evaluating this candidate’s
application.

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

Printed name

Signature of reference Date

For official use only:

Reference verified by: Rep ID:

Method of verification: Date: