151 East 6100 South, Suite 200

Murray, Utah 84107

Au Pair Checklist 801.255.7782
www.GoAuPair.com

The Au Pair Application Package is designed to meet the requirements of the US Department of State and the needs of Host Families. The
US Department of State requirements are defined in the U. S. Department of State Au Pair Program Regulations. The additional
information requested is based on Go Au Pair’s experience in the market and information requested by the Host Families that they feel is
helpful in determining which Au Pair to select.

Form Provided by
Doc ID. Document Name Description/Comments Completed By Go Au Pair
Checklist of all items required to complete the au pair International
APS-010 Au Pair Checklist application Representative Yes
APS-020 Au Pair Instruction Sheet Simple checklist of all the items needed Au Pair Yes
APS-050 Au Pair Application Form Form documenting the au pairs profile Au Pair Yes
Additional Childcare Can be used to document more than the 3 childcare
Experience experiences allowed on Application Form Au Pair Yes
Additional Employment Can be used to document more than the 1 employment
Experience experience allowed on Application Form Au Pair Yes
One page documenting each experience with a child
under the age of two and how many hours of
APS-070 Under 2 Verification Form experience Au Pair Yes
Typed letter to a host family describing the personal
feelings of the au pair, why they want to be an au pair.
APS-090 Au Pair Letter to Host Family Best opportunity for au pair to “sell” themselves Au Pair
APS-100 Au Pair Picture Collage Collage of personal photos selected by the au pair. Au Pair
Email at least 6 Photo files (JPG) that have not been
APS-100 Au Pair Photo files cropped/ edited, at least 400x400 pixels in size Au Pair
Copies of their high school, and/or university diploma,
School Diploma/Certificates - all certificates of merit, and any additional
APS-110 Copy certifications Au Pair
APS-120 Driver's License - Copy Copy of home country driver’s license Au Pair
Copy of International Driver’s Permit (Required to
International Driver's Permit - drive in US, optional as part of the application
APS-121 Copy package) Au Pair
Copy of passport. Ensure passport number is clearly
APS-130 Passport - Copy shown Au Pair
Instructions will be provided by Go Au Pair to
APS-160 Au Pair Psychometric Exam complete this online test. Au Pair Yes
Au Pair Hartman Personality Written test used to provide the HF with some insight
APS-170 Profile into the au pair’s personality Au Pair Yes
APS-310 Au Pair Agreement Defines agreement between au pair and Go Au Pair Au Pair Yes
APS-410 Physician's Health Report Needed to ensure candidate is physically fit Physician Yes
APS-420 Criminal Report Original government report and translated version Government
Reference (not a relative) for whom au pair provided
APS-430 Child Care Reference #1 child care services Reference Yes
Reference (not a relative) for whom au pair provided
APS-431 Child Care Reference #2 child care services Reference Yes
APS-440 Au Pair Character Reference General reference (not a relative) Reference Yes
Form used to document the in-person interview International
APS-460 Au Pair Interview conducted in English typically lasting 2 hours Representative Yes
Must be signed after DVD training course and
APS-470 Training Verification Form completed prior to matching Au Pair Yes
Au Pair Payment Verification
APS-480 Form To be completed at the time of match Au Pair Yes