J1 Au Pair Application Form
Instructions: Before you start this application, ensure to the have the required documents: Digital Professional Photo, High School diploma, Resume and Driver's License. If you have any questions, please email apply@thepassportja.com
Personal Details
Name
*
First Name
Last Name
Gender
*
Female
Male
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country Residence
Birth City:
*
Birth Country:
*
Resident of:
*
Citizen of:
*
Program Eligibility
Do you have a minimum 400hrs taking care of kids?
Yes I do
Desired Start date for the program
*
-
Month
-
Day
Year
Date
Do you understand that your placement is 12 months in length minimum and can be extended up to 24 months?
*
Yes I do
Describe your personality in detail.
*
Emergency Contact
Name
*
First Name
Last Name
Relationship
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Health History
Do you have an illness that may impair your ability to work?
*
Are you taking any medications?
*
Yes
No
If yes, state:
Are you Covid-19 vaccinated?
*
Yes
No
If yes, state the manufacturer:
Travel History
Do you have travel History within the past 5 years?
*
Yes
No
Do you have a US Visa?
*
Yes
No
Visa Control Number
Visa issue date:
-
Month
-
Day
Year
Date
Visa expiry date:
-
Month
-
Day
Year
Date
Have you ever been denied a visa?
*
Yes
No
If yes, please state why?
Have you ever been denied entry, or your visa revoked?
*
Yes
No
Have you ever been arrested or have any cases before the court?
*
Yes
No
J-1 Program History
Have you participated in any Bridge USA Program?
*
Yes
No
Which program?
For example: Summer Work and Travel
Document Upload
Membership Fee Receipt
*
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of
Program Fee Deposit Receipt
*
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of
Digital Professional Photo
*
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of
Passport Bio Page
*
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of
CV/Resume
*
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of
High School Diploma
*
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of
Drivers License
*
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of
Signed Au Pair J-1 Program Terms and Conditions - S
*
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of
Additional Documents
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of
Signature
*
Submit
Should be Empty: