Host family transfer check

Personal details

Name*

Email address*

Phone number*

Experience with the Au Pair Program

Have you previously participated in the au pair program?
YesNo

If yes, please provide a brief explanation (in which year, through which agency, the au pair’s nationality, and how you experienced the placement).

Family Situation

Please briefly describe your family situation: *
How many children do you have, what are their ages, and is any additional childcare arranged (e.g., daycare or grandparents)?

Are you a single parent? *
YesNo

If yes, how is backup support arranged for the au pair in case of unforeseen circumstances? (If not applicable, please indicate.)

Place of Residence and Registration

In which town or city does your family live?*

Are all family members, including any stepchildren under the age of 12, registered at your address in the Personal Records Database (BRP)? *
YesNo

If not, please provide a brief explanation

Special Circumstances

Does anyone in the household require special care or support, for example due to a medical condition? *
YesNo

If so, please provide a brief explanation

Nationality and Residence Status

Do all family members have Dutch nationality? *
YesNo

If not, do you hold the nationality of an EU country or reside in the Netherlands with a valid residence permit?
YesNo

Please provide a brief explanation

Cultural Exchange

The main goal of the au pair program is cultural exchange.*
How do you plan to introduce the au pair to the Dutch language, culture, and society?

Working Hours and Time Off

The au pair program includes rules regarding working hours. *
Can you guarantee that the au pair will never work more than 8 hours per day and 30 hours per week, and will always have two full days off per week, including at least one full weekend per month?
YesNo

Please provide a brief explanation

Au Pair Room

Please describe the room that will be available for the au pair: *
Where is it located in the house, what is the size, what furniture is included, is there a window that can be opened, and can a lock or latch be installed on the door?

Income

Does at least one parent have a permanent employment contract with a Dutch company and a gross monthly salary of more than € 3,700? *
YesNo

If not: is at least one parent a Director-Major Shareholder (DGA) of a Dutch private limited company (BV)? *
YesNo

If not: is at least one parent the owner of a sole proprietorship registered with the Dutch Chamber of Commerce, with an annual profit of at least €40,000 over the past 18 months? *
YesNo

Start Date and Candidate

What start date do you have in mind for the au pair? *

Do you already have a candidate in mind? *
YesNo

If yes, please also answer the following questions:

Which country is the candidate from?

In which country does the candidate currently reside?

Does the candidate already know someone in the Netherlands?
YesNo

How old is the candidate?

Does the candidate speak English well?
YesNo

Has the candidate disclosed any medical conditions that might affect her ability to perform au pair duties?
YesNo

Does the candidate already have a certificate of unmarried status, with legalization and, if applicable, an English translation?
Note: In the case of a South African au pair, an affidavit is unfortunately not sufficient.
YesNo

Dit veld niet invullen