References can only be accepted from non-family members.

CHILDCARE REFERENCE FORM

Please only type answers
To be completed by a non-family member who the applicant has worked for.
The applicant below has applied to Agent Au Pair to spend a year in America as an au pair. The
information you provide will help us determine whether the applicant is appropriate for the program.
Taking care of children is a serious responsibility and all information you can give us to assist in assessing
the character of the applicant is important.

Name of applicant/au pair: FLOR DE MARIA CARO CALLAÑAUPA

Reference Information:
1. Name of reference: SONIA BAHAMONDI 2. Email Address: SONI19@GMAIL.COM _

3. City/Country of residence: LIMA/CALLAO 4. Telephone: +51925484128

5. May a prospective American Host family call you?
Yes No, I am not speaking English
6. Date: 04/15/2024
7. How long have you known the applicant? 6 YEARS AGO
8. Applicant cared for the children (please tick one box): Alone As Helper With Others
9. Please fill in the matrix below to describe in detail the hours and duties performed by the applicant:
Name of Child Age at Age at From (dates) To (dates) Hours per week Activities done during
beginning end mm/dd/yy mm/dd/yy (average) supervision
Andreil 6 years 7 years 01/01/23 03/01/24 42 hours week I cooked him dinner, taught
Him his homework, told him
stories and made him dance.
Luciana 3 years 4 years 03/01/24 03/01/24 42hours week She and I would play, sing,
watch cartoons and I would
bake her biscuits.

10. Why do you recommend the applicant as a childcare provider?

She is patient , charismatic, calm and very tidy.

11. Please rate the following characteristics of the applicant (in your opinion):
Excellent Very good Good Adequate Poor
Responsibilit y Helpfulness
Skill
Maturity

Agent Au Pair Interviewer’s use

only Date: Signature:
Verified by:
Under 2 years old total care hours: Comments:
Over 2 years old total care hours:

Agent Au Pair- Non-Family Member Reference Form

Version 2-2022
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