Au Pair Participants Registration Form

CFO registration form for Filipino immigrant workers

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INFORMATION SHEET FOR AU PAIR PARTICIPANTS (AU PAIR VISA HOLDERS)

INSTRUCTIONS : Please PRINT letters in the spaces provided.

Please CHECK () appropriate box(es).

(FOR CFO USE ONLY)
AU PAIR no.
OR #

-

Reg. Date [ mm-dd-yy ]

-

Verifier

PERSONAL DATA
Last Name

Suffix

First Name
Middle Name
If married, please state mother's maiden name
DATE OF BIRTH [ mm-dd-yyyy ]

AGE

SEX

CIVIL STATUS

 Male  Female

 Divorced

 Single
 Widow(er)

 Married
 Separated

 Outside of the Philippines

PLACE OF BIRTH
Town / City
Province/ State
Country
ADDRESS & CONTACT NUMBERS IN THE PHILIPPINES

NOT FOR SALE

House No. / Street / Barangay
Town / City
Province

Telephone Number

Cellphone Number

Zip Code

E-mail Address

ADDRESS & CONTACT NUMBERS (Country of Destination)
House No. / Street

City / State

Country

Zip Code

Telephone Number

Cellphone Number

E-mail Address

PASSPORT NUMBER

DATE OF ISSUE [ mm-dd-yyyy ]

VISA NUMBER

DATE OF ISSUE [ mm-dd-yyyy ]

HIGHEST EDUCATIONAL ATTAINMENT

 High School Level
 High School Graduate
 Vocational Level
 Vocational Graduate
AS OF MAY 2012

 College Level
 College Graduate
 Post Graduate Level
 Post Graduate

If vocational / college / post graduate, state course

School Name
Address

ECONOMIC STATUS

 Employed

 Self-employed

 Unemployed

If employed / self-employed, state profession / occupation / business

If unemployed, check the appropriate box

 Housewife

 Student

 Out-of-school youth

 Not reporting any occupation

INFORMATION ABOUT SPONSOR / HOST FAMILY
Name of the head of the Host family

Address abroad

Occupation
Telephone Number

Cellphone Number

E-mail Address

IN CASE OF EMERGENCY-DATA OF NEAREST FAMILY MEMBER IN THE PHILIPPINES

Name

Relationship

Address
Zip Code
Telephone Number

Cellphone Number

FUNDING SOURCE

E-mail Address

MODE OF INTRODUCTION TO THE HOST FAMILY

 Philippine Government
 Private company / organization
 Agencies
 Personal
 Host Family

Personal Introduction
Referred by Family/Relatives
Recruitment Agency*
Thru Internet*

If funded by any organization/agency/training center/company

Thru Organization*

please state the name and indicate its contact information:

Thru Foreign Post*
Training Center/Agency/School

Others*
*please specify

As prescribed in the Guidelines on the Departure of Au Pairs to Europe (signed in February 2012), an au pair is a young Filipino citizen
between 18 and 30 years of age, unmarried and without any children placed in an immersion program in cultural and language training
in a specific European country of destination. He/She shall live with the host family at par (au pair) or on equal basis with immediate
members of the host family, shall be given pocket money, share in child care, light household chores and responsibilities previously
agreed upon in an au pair placement contract between the au pair and the host family.
LIMITATION OF STAY:
Based on the European Agreement on Placement of Au Pairs (November 1969), an au pair is placed under a cultural exchange
arrangement with the European host family for a maximum stay of two years, unless otherwise allowed by the host country.

CERTIFICATION
I have read and understood the foregoing. I understand that it is my responsibility to maintain my Au Pair Status. I certify that
all the information on this form is true and correct to the best of my knowledge.

SIGNATURE ABOVE PRINTED NAME

THIS FORM IS NOT FOR SALE