Host Family Application Form

I understand that by filling out this form I agree with the Terms & Conditions *

A copy of the Terms & Conditions can be found here: https://bit.ly/2QoDJhf

I want to receive newsletters and other au pair related info *

Sign up here: http://eepurl.com/bRy6gX

I understand that I need to send the following documents to to Au Pair New Zealand *

Full name host mother *

Date of birth (DD/MM/YEAR) *

Nationality as shown on passport *

Occupation *

Interests & hobbies *

Address *

House number, street, location, postal code, county

Land line *

Mobile phone *

Email *

Skype ID *

Facebook ID *

Welcome to follow us on Facebook: https://www.facebook.com/aupairnewzealand/

Instagram *

Join our IG community: https://www.instagram.com/aupairnz

Do you suffer (or have suffered) from a medical/mental health condition? *

Please note that your info will be treated confidential and that we will discuss this during our interview with you.

If yes, what condition (please elaborate)? *

Have you ever been convicted for a crime? *

If yes, please elaborate

Have you applied for a copy of your criminal record? *

You are obliged to send us a copy of your criminal record before we can place an au pair in your family. A form can be obtained here: https://www.justice.govt.nz/criminal-records/get-your-own/

Date you submitted the application (DD/MM/YEAR)

Full name host father *

Date of Birth (DD/MM/YEAR) *

Nationality as shown on passport *

Occupation *

Interests & hobbies *

Address (if different than the above) *

House number, street, location, postal code, county

Land line (if different from the above) *

Mobile phone *

Email *

Skype ID *

Facebook ID *

Welcome to follow us on Facebook: https://www.facebook.com/aupairnewzealand/

Instagram *

Join our IG community: https://www.instagram.com/aupairnz

Do you suffer (or have suffered) from a medical/mental health condition? *

Please note that your info will be treated confidential and that we will discuss this during our interview with you.

If yes, what condition (please elaborate)? *

Have you ever been convicted for a crime *

If yes, please elaborate *

Have you applied for a copy of your criminal record? *

You are obliged to send us a copy of your criminal record before we can place an au pair in your family. A form can be obtained here: https://www.justice.govt.nz/criminal-records/get-your-own/

Date you submitted the application (DD/MM/YEAR) *

Full name child 1 *

Date of birth (DD/MM/YEAR) *

Does your child *

What are the child's interests & hobbies *

Does your child have a special need (disability, allergy, medication) *

If yes, what type of special need and what do you expect from the au pair *

Please note that the au pair is not a trained child carer and that they shall not perform duties that require special childcare skills.

Full name child 2

Date of birth (DD/MM/YEAR)

Does your child

What are the child's interests & hobbies

If applicable, if not just write N/A.

Does your child have a special need (disability, allergy, medication)

If yes, what type of special need and what do you expect from the au pair

Please note that the au pair is not a trained child carer and that they shall not perform duties that require special childcare skills.

Full name child 3

Date of birth (DD/MM/YEAR)

Does your child

What are the child's interests & hobbies

If applicable, if not just write N/A.

Has your child a special need (disability, allergy, medication)

If yes, what type of special need and what do you expect from the au pair

Please note that the au pair is not a trained child carer and that they shall not perform duties that require special childcare skills.

Full name child 4

Date of birth (DD/MM/YEAR)

Does your child

What are the child's interests & hobbies

Has your child a special need (disability, allergy, medication)

If yes, what type of special need and what do you expect from the au pair

Please note that the au pair is not a trained child carer and that they shall not perform duties that require special childcare skills.

If you have babies (0-12 months), will the au pair *

Please note that the au pair is not a trained child carer and that they shall not perform duties that require special childcare skills such as the care for babies on their own.

If your au pair has sole charge, please explain what you expect from them *

It is not very common to have an au pair look after very young children solely by themselves as they are not trained nannies.

Relationship status *

Does anyone in your household have children from a previous relationship? *

If yes, do they live with you? *

If not or only occasionally, please elaborate on how often they visit *

What are the names of the children, their date of birth, hobbies and special requirements. Where do they live and does the au pair need to look after them as well? Please provide us with as much info as possible.

How often do your or your partner's children spend time with the other parent? *

Please provide as many details as possible (days of the week, time, holiday arrangement etc).

Will your au pair need to work for the other parent as well? *

If yes, how often (please elaborate)? *

Please provide as many details as possible (days of the week, time, etc.). If you au pair works for the other parent, they need to fill out the application form and provide all documents as well.

Do you have pets/farming animals? *

What pets/farm animals do you have?

If not applicable, just write n/a.

Which pets live in the family home?

Is pet care required? *

Please note that the au pair is in the first place assisting you with childcare and that they can refuse to look after pets / farming animals as this is not part of their job as an au pair.

If yes, what type of care do you expect from an au pair?

Please note that the main task of an au pair is looking after the children.

What is your religion (if applicable)? *

Do you practise your belief (going to church, praying before a meal)? *

Do you require the au pair to have the same religion? *

Can the au pair practise their own religion? *

e.g. going to church

What language(s) do you speak in the family home? *

What method do you have to raise/educate your child(ren)? *

Have you had an au pair before? *

If yes, where did you find your au pair? *

How did you find out about Au Pair New Zealand? *

Multiple answers possible.

What key words / phrases did you use to find us? *

Does anyone in your household smoke? *

If yes, do you smoke *

Location of your house *

Would you describe your house as *

Within 15 mins. driving from the family home you find *

Does your au pair have their own bedroom? *

Is the bedroom situated in the family house? *

If not, what accommodation do you offer for your au pair. *

Please elaborate and also let us know if the au pair can spend time in the family home if the room is not in the house.

What accessories are provided in your au pair’s bedroom? *

Multiple answers possible.

Does your au pair have their own bathroom? *

If not, please explain

What accessories in the house does your au pair have access to? *

Please elaborate as much as you can.

Preferred age group of your au pair *

Please note that despite their young age, some au pairs are very mature and have great life experience. We ask you to have an open mind.

Previous child care experience *

Please note that au pairs are not nannies and have no qualified training.

Do you accept male au pairs? *

Do you accept au pairs who have limited English language skills? *

Au pairs always learn fast when they are in NZ as they are exposed to an English speaking environment. The au pair also comes to NZ to improve their language skills.

Smoking is *

Special dietary requirements you are ok with *

Multiple answers possible. Please note that many European au pairs do not eat meat, but are ok when the family eats meat. It can be arranged that extra vegetarian / vegan food can be bought for the au pair and is deducted from the pocket money. This shall be discussed both with APNZ and the au pair.

What language(s) do you want the au pair to speak? *

Do you need an au pair with a driving licence? *

Would you accept an au pair without a driving licence? *

Do you want your au pair to have a special skill? *

If yes, what skill (please elaborate)? *

If your answer is no, just write N/A.

How many hours do you want your au pair to work per week? *

I agree to pay my au pair the min. wage of 21.20 NZD or give them time off in lieu when they do overtime *

The current minimum wage is valid from 1 April 2022.

If the au pair works 30 hours or less per week, they can do other work elsewhere *

Other work can eg. be additional babysitting or work in hospitality

Schedule (Monday to Sunday) *

Please provide the au pair's working schedule as detailed as possible. These hours shall correspond with those in the contract between yourself and the au pair.

Which 2 consecutive days will your au pair be off? *

Please describe the tasks of the au pair *

Please provide the au pair chores as detailed as possible. These tasks shall correspond with those in the contract between you and your au pair.

Net pocket money per week. *

The au pair's salary consists of net pocket money, board and lodging. Payment is based on the minimum wage per hour, the cost of accommodation, electricity, internet use and food .

I understand that I am the au pair's employer and have to pay taxes on top of the net pocket money. *

More information about how to register as an employer can be found on https://bit.ly/2DA4Zna

Do you want the au pair to prepare meals for *

If you want the au pair to prepare meals for the whole family, please advise if you will assist or if you will let them know what meals you want them to prepare.

Do you eat together as a family? *

If not, please describe your family routine for meals *

Please write n/a in the box above if you do eat together.

Who will prepare meals on the au pair's day off? *

Do you have a cleaner *

Do you want your au pair to clean? *

Please note that the au pair's main duties are to provide childcare.

Please explain what cleaning you expect from your au pair

Do you provide a car during working hours? *

The host family shall make sure they pay for petrol and insurance.

Can the au pair use the car in their spare time? *

If yes, do they need to pay for petrol?

What car insurance policy do you have for the au pair? *

As a host family, you are liable to pay the excess if your au pair has an accident or causes damage (that was not pre-existing) to the vehicle during working hours. If your au pair is allowed to use your car in their spare time, they will be liable to pay the excess if they have an accident or cause any damage that was not pre-existing) during this time unless there is an agreement in place between you and your au pair.

What is your insurance excess (in NZD)? *

Have you planned any holidays in the future? *

If yes, will the au pair be asked to join?

If you go on holiday during the time your au pair is supposed to work and they are not asked to join, the au pair will still receive the weekly amount of pocket money during that time and funds for food expenses. If the au pair joins and does not work, the family shall pay the au pair’s flight, insurance, accommodation, food and any other expenses (except for personal expenses) that are also covered for other members of the family.

If yes, will the au pair have to work?

If the au pair do their standard hours, they will receive their standard pocket money. If they only work occasionally, you shall pay the au pair the minimum wage.

Extras for the au pair *

Please explain if you replied 'other'

Earliest preferred start date of the au pair (DD/MM/YEAR) *

Latest preferred start date of the au pair (DD/MM/YEAR) *

How long do you need an au pair for (weeks)? *

Name Emergency Contact *

First

Last

Who is the first point of contact that we should touch base with in case of an emergency when you are not available.

Email *

Mobile number *

Landline *

Relationship with you *

Family GP *

First

Last

Address *

House number, street, location, postal code, county

Landline *

Family reference 1 *

First

Last

By giving the details of you references, you agree that we can contact them without giving you prior notification. We do not accept family members.

Relationship with you? *

How long have you known each other for? *

Occupation *

Mobile number *

Landline

Email *

Family Reference 2 *

First

Last

By giving the details of you references, you agree that we can contact them without giving you prior notification. We do not accept family members.

Relationship with you? *

How long have you known each other for? *

Occupation *

Mobile number *

Landline

Email *

I hereby declare that all information provided in this form is true and correct and that I will inform Au Pair New Zealand about any changes. *

Please write your name in capital letters and the date of submission below.

Host Family Application Form

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