Asia-Bridge-Childcare
Initial Au Pair Application Form
Email *
Nickname (in English) *
First Name (in English) *
Middle Name (in English)
Family Name (in English) *
Nickname (in Thai) *
First Name (in Thai) *
Middle Name (in Thai)
Family Name (in Thai) *
Phone Number *
Line ID *
Address (on National ID) *
Address (current mailing or living address, if different from ID)
Age *
Birth Year *
Birth Month *
Birth Date *
Do you have a Driver's License? *
If yes, what year did you receive a driver's license? (YYYY)
Criminal Record? *
Criminal Record (if yes please explain)
Medical History
If applicable
List any medical conditions which may affect your ability to work as a nanny
List any current prescription medications
List any current psychological concerns
Allergies to food or pets
References
Please provide two character references who are not relatives (can be friends, coworkers, teachers).
Reference 1 (Name) *
Reference 1 (Relationship to you) *
Reference 1 (Phone) *
Reference 1 (Email) *
Reference 2 (Name) *
Reference 2 (Relationship to you) *
Reference 2 (Phone) *
Reference 2 (Email) *
Education and Certifications
Highest level of education completed, and/or current school attending.
Highest Level of Education Completed
School / University Name *
Level (Highschool, Tech School, Undergraduate, Graduate) *
Degree or Diploma Earned (Highschool, AA, BA, BS, etc) *
Major or specialty (English, Nursing, History, etc) *
Year Completed *
School Currently Attending
If applicable
Current School / University Name
Current Level (Highschool, Tech School, Undergraduate, Graduate)
Degree or Diploma, Future (Highschool, AA, BA, BS, etc)
Current Major or specialty (English, Nursing, History, etc)
Year of Expected Completion
First Aid or CPR Training *
Formal Childcare Training Certification *
Formal Childcare Training Certification Description
Any Additional Relevant Training (music, art, coaching, medical)
Hobbies *
Employment History
List relevant employers (if applicable)
- Start date & End date
- Employer name
- Duties / responsibilities
Employment History (Answer field)
Childcare Experience
Select Childcare Experience Type
Select Experience Ages
Childcare Experience Details: feel free to share any details you believe are relevant, ex total hours, child age preferences
Authorization
- I acknowledge that Asia Bridge Childcare Co., Ltd, (the “Agency”) may request a reference check, which may include information on my character, general reputation, education, personal characteristics, driving record, police record, and past employment. I hereby authorize the Agency to obtain any such information.

- I acknowledge that I have read and understand this statement and that, to the best of my knowledge, the information provided in this application is true and correct.

- I agree to release and hold the Agency harmless for any act of the employer. I also agree to hold the Agency harmless of any claim as a result of any placement in which I am a part.
I acknowledge and agree to the above *
Required
A copy of your responses will be emailed to the address you provided.
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