AU-PAIR WORLD AGENCY SWEDEN
Museigatan 2
SE-451 50 Uddevalla
SWEDEN
CHILDCARE REFERENCE FORM
/to be filled out the employer/family/
Name of applicant: ...................................................................................................
Name of employer/family: .......................................................................................
Address: ....................................................................................................................
Phone/mobile-daytime: ..........................................................................................
Phone/mobile-evenings: ........................................................................................
How do you know the applicant: ............................................................................
Please state the time period/periodsthe applicant worked for you:
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Did she/him work for you on a regular basis? How often?
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Please give the number and age of children she/him looked after?
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How old where the children when she/him first started looking after them?
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Did she/him help with household duties? If yes, which ones?
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Please give details of how the applicant got on with your children and other members
of your family. It is important to consider the fallowing aspects, affection and
understanding of children, useful leisuretime activities, sense of responsibility for children,
etc.
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Do you think the applicant is mature and responsible enough to look after and care for children as Au-Pair?
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Date: .......................................................Signature: ................................................