Au Pair Application

Dear future au pair,

Thank you very much for your interest in becoming an au pair in the Netherlands through Au Pair
Amsterdam. Before we can start searching for a host family to match you with, we need to learn more
about you. Please carefully fill out this application in English and submit it by email to
[email protected].
Note that there are strict requirements about who can become an au pair in the Netherlands.
Some of these requirements include: between the ages 18-31, possession of a valid travel document, and
have not previously stayed illegally in the Netherlands. For more detailed information about au pairing in
the Netherlands please visit the Immigration and Naturalisation Services (IND) website: www.ind.nl.
The application process scan be overwhelming, so here is a short explanation of the steps
involved. First, you must fill out this application form on a computer. When you are finished, sign and date
the last page and submit by email. Once your application is received, it will be processed to see if there is
a potential match with a host family. If there is a potential match, someone from Au Pair Amsterdam will
contact you to schedule an intake interview.
After your intake interview, you must submit various documents to verify that you are indeed a
qualified candidate for the au pair program. From the moment there is a match between you and a host
family, you must submit more official documents. Some of these documents must be collected in your
home country, and others come from the IND. Au Pair Amsterdam will assist you with gathering these
documents when the time comes.
We look forward to receiving your application, matching you with a host family, and welcoming
you to the Netherlands!

With kind regards,

Au Pair Amsterdam

Au Pair Amsterdam
www.aupairamsterdam.com
[email protected] skype: aupair_amsterdam
 Au Pair Application
Insert three photos in the space below: one of you, one of you together with a child, and one of you together
with your family.

Instructions: from the menu, select “Insert”, then select “Photo”, then select “Photo from file”. Choose your
photos. Once the photos are inserted in this Word document, you can manipulate the sizes of the images, so
the application document will not be too large in size.

1 2 3

I Personal information
First name :
Surname / Last name :
Date of birth :
Place of birth :
Nationality :
Passport number :
Date issued and expiration date :
City and country of issue :
Available as of :
How long do you wish to work : (Maximum stay is 12 months)
as an au pair?
Do you have previous experience as an au pair?
Country:
Dates worked:
Ages of children:
Responsibilities:
Name of host family:
Telephone number:
E-mail address:

II Contact information
Phone number (home) :
Mobile number :
Address :
Postal code / Zip code :
City :
Country :
E-mail address :
Skype username :
Facebook address :
Emergency contact : (Name, telephone, e-mail, language)

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 Au Pair Application
III Family background

Father’s occupation :
Mother’s occupation :
Name and age of sibling(s) :
Your civil status : (Single, married, separated, divorced)
Are you in a relationship? : (If yes – explain where your partner lives and how you maintain
your relationship)
Religion/spiritual practice :
How do you practice your : (Specify if you have any special religious needs)
religion?
Are you willing to live in a family :
who has another religion?
Where did you grow up? : (Capital, city, town, village, countryside)
Where do you live now? : (Capital, city, town, village, countryside)

IV Occupation and Education

Present occupation / profession : (Job description, hours per week, start and end date)
Professional reference : (Name, telephone, e-mail, language)
Highest level of education :
Name of institute :
Dates of attendance :
Diploma :
Language skills : (Note that English fluency is required)

V Motivation
What is your motivation for becoming an au pair? 
(Explain here what inspired you to become an au pair and why you believe you are a good candidate
for the au pair program)
What do your family and friends think of your wish to become an au pair? 
…
Do you know anyone in the Netherlands or other European countries?
(If yes – explain your relationship)
Are you willing to learn Dutch?
…
How would you spend your free time in the Netherlands?
…
What is your previous experience traveling inside and outside of your home country?
…
Are you interested in traveling to other cities in the Netherlands or other countries in Europe
during your time as an au pair?
(If yes – where and why?)
What do you plan to do after the au pair program?
…

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 Au Pair Application
VI Childcare experience and skills
Describe your childcare experience.
(Mention the responsibilities, ages of the children, and dates worked)
What would you do to entertain the children?
…
What would you do if a child gets ill?
…
How would you discipline the children?
…
Do you have a first aid /CPR certificate? :
Are you willing to accept a family with a :
baby?
How many children are you willing to care :
for?
Are you willing to accept a family with :
pets?
Are you willing to take care of a disabled :
child?

VII Household experience and skills

What kind of experience of light household chores do you have?
…
How would you describe your housekeeping style?
(Messy – neat)
Can you do cooking? What kind of dishes can you prepare?
…
Are there any types of household chores that you are not willing to do?
…

VIII Other
Give a short description of your strong and weak personality characteristics.
…
Give a short description of your hobbies and interests.
…
Do you suffer from home-sickness?
…
Do you live on your own? / Have you ever lived on your own?
…
How would you describe your personal appearance?
(Do you have tattoos or piercings? Do you use makeup? How do you describe your dressing style?)
Can you swim? :
Can you ride a bicycle? :
Are you willing to ride a bicycle :
with a child’s seat?
Do you have a driving license? :
Do you have an international :

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 Au Pair Application
VIII Other
driving license?
Do you have any experience :
driving in snow?

IX Host family
Do you have any special wishes concerning your host family?
…
Where do you want to live?
(Capital, city, town, village, countryside)
How will you adjust to a new family, new country, and new culture?
…
What type of relationship would you like to have with your host family?
…
If after a few weeks you find the position is not working out, how would you deal with it?
…
Are you willing to work for a single mother or father? 
…

X Health
Are you in good health?
…
How often have you been ill over the last year?
…
Do you follow a specific diet (e.g. vegetarian)?
…
Are you an energetic person; are you able to work hard?
…
Do you smoke?
(Understand that if you are a smoker, you are not allowed to smoke near the children nor inside the
house. If you are dishonest, your program could be in jeopardy.)
Do you take any medication?
…
Do you have any allergies?
…

XI Dear host family letter

Write a short introduction letter about yourself to your future host family.
Dear future host family,

(Explain: why you want to become an au pair; study; childcare and work experience; interests and
hobbies; how would a friend/family member describe you as a person; what do you expect from this
year as an au pair?)

Sincerely,

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 Au Pair Application
XI Dear host family letter

XII Immigration
Do you have any other reason for travelling to the Netherlands, besides your participation in the
au pair program?
…
Why did you decide to take part in the au pair program of the Netherlands, instead of another
country such as Germany or France?
…
What information do you know about the Netherlands in terms of geography, language and
culture?
…
Do you know someone in the Netherlands? If yes, provide the name and contact persons of this
person. Specify the relationship you have with this person.
…
Have you ever been in the Netherlands before? If yes, mention the dates and the purpose of your
visit.
…
Did you ever apply for a visa with the aim to travel to the Netherlands?
…
Did you ever reside in the Netherlands on the basis of a residence permit?
…
Do you realise that you will be allowed to stay in the Netherlands for a maximum period of 12
months, starting on the date of entry into the Netherlands?
…
Do you realise that you must return to your home country again after your au pair year?
…
Explain the main purpose of the au pair program.
…
Explain which kind of tasks an au pair is allowed to do.
…
Explain how many hours an au pair is allowed to work per day and per week.
…
How much pocket money is an au pair entitled to?
…
Is an au pair allowed to work, paid or unpaid, outside of the au pair program in the Netherlands?
…
What would you do if the host family would violate the rules of the au pair program, for example
if they would ask you to babysit for 10 hours per day?
…
How do you intend to stay in touch with Au Pair Amsterdam during your exchange year?
…
Are you aware of the fact that au pairs must report any change in their situation to Au Pair
Amsterdam immediately (within 24 hours after the change has occurred)?
…

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 Au Pair Application
XIII Identification Documents
- Insert a scan of the photo page of your passport below.
- If you are already living abroad, also insert a copy of both sides of your residence permit.
Instructions: from the menu, select “Insert”, then select “Photo”, then select “Photo from file”. Choose your
photos. Once the photos are inserted in this Word document, you can manipulate the sizes of the images, so
the application document will not be too large in size.

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Au Pair Application

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 Au Pair Application
Full name as stated on the passport :

Passport number :

Place :

Date :

Signature :

I hereby declare that:

 I have a valid passport for the entire duration of my stay;

 I have no criminal record and/or I have never had a criminal conviction;
 I have a good general state of health;
 I have read, understood and agree to the conditions mentioned in the au pair
program and information provided by Au Pair Amsterdam;
 All information above is true and complete. Withholding any information that should
have an impact on my stay as an au pair with as host family can lead to my dismissal
as an au pair and I understand that I can be sent home immediately;
 I have not paid more than € 34,- for, e.g. mediation- and/or registration costs and/or
to follow a preparatory course (appointed by the government in the country of
origin) for staying in the Netherlands provided by a (Dutch or foreign) agency or
exchange organisation;
 I have not paid a deposit to a (Dutch or foreign) agency or exchange organisation;
 I did not sign/will not sign a contract with a host family, a (Dutch or foreign) agency
or exchange organisation obligating me to pay a fine as a penalty for breaching the
contract.

…………………………………………………........ …………………………………………………........
Full Name (Please print) Signature

…………………….. …………………………...............
Date Place

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