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Personal Information

First Name*

Last Name*

Phone Number

Email*

Street

City

State

Postal Code

Home Country*

Have you successfully completed an American J-1 au pair program before?*

Yes No

Your Questions

Do you enjoy and have experience taking care of children?*

Yes No

Are you able to provide references for your childcare experience?*

Yes No

Are you between the ages of 18 and 26 years old?*

Yes No

Are you proficient in speaking English?*

Yes No

Do you have your secondary school (high school) diploma?*

Yes No

Do you have a valid passport or could you obtain one?*

Yes No

Do you have a valid driver's license or could you obtain one?*

Yes No

Are you in over-all good health? (i.e. free of health problems that would not allow you to travel and take care of children)*

Yes No

Are you clear of any criminal records?*

Yes No