CHILD CARE REFERENCE

All references must be in language of the chosen country. If this is not possible the text should be translated by you . we encourage you to provide as many child references as possible. Please photocopy this page if you can give more references.

NAME OF THE AU PAIR .........................................................................................................

HOW LONG HAVE YOU KNOW HER / HIM ? .....................................................................

IN WHAT CAPACITY DO YOU KNOW HER / HIM ? (friend, employer , teacher ) ............

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ARE YOU FAMILY OF THE AU PAIR ? ................................................................................

FOR HOW LONG HAS SHE / HE BEEN CARING FOR YOUR CHILDREN ? ...................

WHEN DID SHE LAST TIME LOOK AFTER THEM ? .........................................................

HOW OFTEN DOES SHE / HE WORK FOR YOU ? ..............................................................

PLEASE EXPLAIN WHAT SHE / HE HAS TO DO WHEN SHE WORKS FOR YOU .......

..............................................................................................................................................................................................................................................................................................................PLEASE GIVE THE NUMBER AND AGES OF CHILDREN SHE / HE CARED FOR .......

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DO YOU THINK SHE / HE WILL BE A GOOD AU PAIR ? PLEASE EXPLAIN WHY DO YOU THINK SO ...................................................................................................................

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PLEASE GIVE YOUR IMPRESSION ON THE FOLLOWING QUALITIES ( proszę określić poniżej wymienione cechy ) :

Þ Love of children ...................................................................................................

Þ Responsibility / maturity .....................................................................................

Þ Ability to fit in with a family ..............................................................................

NAME....................................................................Tel .................................................................

ADDRESS....................................................................................................................................

SIGNATURE .............................................................. DATE .................................................

Please note that information may be shared with prospective Au Pair families.

Informujemy , że podane przez Pana / Panią informacje będą przetwarzane na potrzeby firmy.