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Au pair hosting application dossierThis application consists of:1. The application for approval of the host family2. The application for approval of the young au pair3. The au pair hosting agreement specifying the rights and duties of each partyThis application must be signed by both parties and sent by mail (post) before the start of the au pair hostingto the following address:Service national de la jeunesseAccueil au pair33, Rives de ClausenL-2165 LuxembourgIntroductory remarks:The application must be duly completed, signed and accompanied by the required supporting documents. Incomplete applications cannot be processed and will be returned to the applicant. The processing of an application may take up to 4 weeks from receipt of the complete file.This form is one of the key first steps in the procedure to access the au pair program and is the foundation of this enriching cultural experience. In this respect, it is worth mentioning that the au pairprogram is based on mutual trust between the host family and the young au pair. Therefore, it isstrongly recommended that the host family and the young au pair provide the required informationaccurately and truthfully.

TABLE OF CONTENTSI.Au Pair Hosting Application . I-1Article 1.General terms and conditions. I-1Duration of the au pair hosting . I-1Article 2.Identification of the two contracting parties to the au pair hosting agreement . I-2The host family . I-2The young au pair . I-2Article 3.Obligations of the host family . I-3Composition of the host family . I-3Housing situation. I-4Domestic staff . I-4Language skills . I-4The young au pair’s single room . I-4Pocket money . I-5Language courses and culture. I-5Other obligations . I-5Article 4.Obligations of the young au pair . I-6Article 5.Language skills of the young au pair . I-7Legal obligations . I-7Language skills . I-7Language courses . I-7Article 6.Tasks of the young au pair . I-8Article 7.Projected weekly schedule . I-8Article 8.Other provisions. I-9Arrangements for the payment of travel expenses . I-9Assumption of the expenses related to the residence permit . I-9Participation of the young au pair in family leave . I-9Arrangements related to days of rest . I-9Others . I-9Article 9.Supporting documents required . I-10Supporting documents - host family . I-10Supporting documents - young au pair . I-10Article 10.II.Final provisions .I-11Annex 1: Fact sheet – Tasks of the Au pair . II-1Supervision of children . II-1Light household tasks Washing, ironing, folding children's laundry. II-1Tasks not to be performed by the au pair, unless the au pair explicitly agrees to them . II-2III.Annex 2: Projected weekly schedule . III-1IV.Annex 3: Sworn statement “Day-care” . IV-1V.Annex 4: Medical certificate . V-1VI.Annex 5: Sworn statement “Family ties” . VI-1VII.Annex 6: Processing of personal data . VII-1What personal data is processed by the SNJ? . VII-1For what purposes is this personal data collected? . VII-1

To whom is the collected personal data transmitted? . VII-2How does the SNJ protect the personal data it processes? . VII-2What rights do families and young au pairs have? . VII-2Law enforcement and judicial procedure: . VII-3

I.AU PAIR HOSTING APPLICATIONArticle 1.General terms and conditionsFor any young person, au pair hosting is likely to be a rewarding experience, serving as an opportunity toperfect their language skills and broaden their cultural horizons. To this end, the young person will be providedwith accommodation and food by their host family living in the Grand Duchy of Luxembourg, who will enrollthem in language training and cultural activities of their choice and will bear the related costs.This program can also be very interesting for the hosting family on several levels. In particular, it is an opportunity to welcome a young foreigner with a different cultural portfolio from that of the family and to integratethem as a full member of the family for a fixed period of time. Although the young person's participation infamily and household chores is not the main purpose of the stay, the family benefits from the young person'ssupport in the daily supervision of their young and older children as well as in the organization and performanceof light household chores.Nevertheless, the strong emphasis of the au pair stay must be on cultural exchange: both the au pair and thehost family benefit from it.In Luxembourg, the hosting of au pairs is regulated by the law of 18 February 2013. With this law, the Luxembourg legislator has created a solid framework within which the temporary residence of a young person agedbetween 18 and 29 years can take place. In this respect, it should be remembered that the young au pair mustbe at least 18 years old and less than 30 years old at the beginning of the au pair placement. The law confersa specific status upon the young au pair.Duration of the au pair hostingIn any case, the duration of the au pair hosting may not exceed one year. Should the duration and period ofthe hosting change, the host family undertakes to inform the National Youth Service (“Service national de lajeunesse”, hereinafter referred to as "SNJ") of the new dates by sending an amendment to the agreement,duly containing the new dates of arrival and departure, always taking into account the one-year limit.The young au pair will be hosted in the host family for a period of:FromToDuration in monthsDuring the hosting period determined by the family together with the young au pair, the family will ensure thatthe young au pair can make the most of this opportunity to pursue the main objective of the au pair program,namely, the discovery of the Grand Duchy of Luxembourg and the familiarization with its cultural aspects. Thehost family will involve the au pair fully in their everyday family life and will enable them to improve their language skills by attending language classes. In addition, the host family will support the young person in theirwill to broaden their general cultural knowledge, in particular by discovering the Grand Duchy of Luxembourgand through regular participation in the country's cultural activities.I-1

Article 2.Identification of the two contracting parties to the au pairhosting agreementThe host familyHosting family approval number (if already allocated by theSNJ)FM Mrs / Ms / Mr (Name and Surname)Phone number(s)E-mail addressAnd (if applicable) Mrs / Ms / Mr (Name and Surname)Phone number(s)E-mail addressPlace of residenceAddress - street and numberAddress - postcode and village/town/cityThe young au pair Mrs / Ms / Mr (Name and Surname)Date of birthPhone number(s)E-mail addressI-2

Place of residence in the country of originAddress - street and numberAddress - postcode and village/town/cityCountryCurrent place of residence (if different from home country)Address - street and numberAddress - postcode and village/town/cityCountryArticle 3.Obligations of the host familyThe host family undertakes to temporarily host the young au pair with their family and to involve and includethe young au pair in their everyday family life. In this respect, the host family makes the following declarations,which the au pair acknowledges and formally agrees to:Composition of the host familyNumber of adult(s)Number of children 6 yearsNumber of children 6 – 13 yearsNumber of children 13 yearsTotal :0The host family must have at least one child among its members who has not reached the age of 13 at thebeginning of the au pair's stay. For children who have not yet reached the age of 6, the family must provideevidence that their day-care has been organized and will be guaranteed for the duration of the au pair's stay.I-3

Housing situation Detached house ApartmentCompositionNumber of bedroom(s)Number of bathroom(s)Domestic staffStaff designationHours per weekLanguage skillsUsual languageOther language skillsThe young au pair’s single roomThe family provides the young au pair with a single room and gives them free access to their home. The singleroom includes the following conveniences:I-4

Pocket moneyEach month the host family will pay the au pair a fixed amount as pocket money. The payment will be madeon a fixed day of the month without exception throughout the duration of the stay, regardless of any periods ofinactivity of the young au pair. In exceptional cases and provided that the young person does not yet have apersonal bank account, pocket money can be given in person against a compulsory receipt.The host family will pay the following amount:Amount ( ) 1Day of the paymentThe reference of the transfer will explicitly specify that it is the au pair's pocket money. In addition, the reference shall include the approval number and the month to which the amount transferred relates 2.Language courses and cultureThe host family will allow sufficient time for the au pair to improve culturally and to attend language courses.Language courses the young au pair will doOther obligations The host family will provide the au pair with food and accommodation. The host family will cover the costs of the language course taken by the au pair. The host family will allow the au pair a minimum of three evenings off per week, in addition to one fullday off per week and two additional days off per month. The schedule may not exceed 5 hours perday and 25 hours per week. The family will release the young au pair from her/his duties in order to be able to participate in theinformation session organised by the SNJ in the month following her/his arrival. In the event of illness of the young au pair, the host family shall continue to provide them withaccommodation and food, and ensure that all appropriate care is given to the young au pair until thenecessary arrangements have been taken. The family reserves the right to request a medicalcertificate stating the reason for the impediment and the foreseeable duration. The host family will ensure the possible early repatriation of the young au pair due to illness, accidentor withdrawal of approval of the young au pair. The host family shall take out civil liability insurance for the young au pair from an authorised insurerin Luxembourg and register the young au pair with the statutory accident insurance scheme inaccordance with Articles 1 and 85 of the Social Security Code for the duration of the au pair hosting.It provides the SNJ with a certificate of the young au pair's affiliation to the legal health and accidentinsurance scheme within one month of the start of the au pair hosting. The host family agrees to authorise access to its home to agents of the SNJ in accordance with Article6 (3) of the law of 18 February 2013 on the hosting of young au pairs.1The amount must correspond to at least one fifth (1/5) of the minimum social wage. The amount in force is published l2Example: FM202012345 - Au pair pocket money - May 2020I-5

The host family is obliged to inform the SNJ of the final date of arrival, if this date differs from the oneplanned by the young au pair before the start of the hosting. The host family will inform the SNJ if the host project is cancelled and will be sure to give grounds forthe cancellation. The host family must provide the SNJ with a projected schedule countersigned by the young au pairprior to the start of the au pair hosting. (see point 6 of this form) The host family confirms that they have no family ties up to and including the fourth degree with theau pair. In the event of a conflict or disagreement with the young au pair, the host family agrees to requestmediation from the SNJ. In order to make an appointment for mediation purposes, the host family'srepresentative will send an e-mail to the manager of the au pair department at the SNJ ([email protected]).Article 4.Obligations of the young au pair The young au pair confirms that he/she is at least 18 years of age and under 30 years of age at thestart of the hosting. Upon their arrival, the young au pair will take part in a mandatory information session organised by theSNJ. By signing this form, the young au pair confirms that he/she is in compliance with the legislationconcerning the entry and stay of foreigners. The young au pair must attend language courses during the au pair hosting period. It is strictly prohibited for the young au pair to work as an employee or self-employed person duringthe au pair hosting period. The young au pair will inform the SNJ of their arrival during the first week of their stay (by email:[email protected]). The young au pair will report as soon as possible any problems with the stay at the SNJ (by e-mail:[email protected]). The young au pair agrees to inform the SNJ of any changes to their contractual situation as a youngau pair (by e-mail: [email protected]). The young au pair declares to have taken note of the obligations and information of the host familyand in particular to have taken note of the language(s) used by the host family. The young au pair confirms that they have no family ties up to and including the fourth degree withmembers of the host family. In the event of a conflict or disagreement with the host family, the young au pair agrees to requestmediation from the SNJ. In order to make an appointment for mediation purposes, the young au pair’srepresentative will send an e-mail to the manager of the au pair department at the SNJ ([email protected]).I-6

Article 5.Language skills of the young au pairLegal obligationsThe young au pair takes note of Article 3 (4) of the law of 18 February 2013 on the hosting of young au pairs,which reads as follows: "The au pair must have a basic knowledge of one of the languages spoken by the hostfamily as well as English or one of the three administrative languages as defined by the law of 24 February1984 on the language regime. " 3.Language skillsIn view of the above, the young au pair declares that he/she understands and speaks the following languages:Language usedLevel reachedGermanEnglishFrenchOthers:In order to assess his or her language skills, the young au pair must refer to the Common European Frameworkof Reference for Languages (CEFRL). The young au pair must have reached level A2 in either German, English or French.Language coursesThe young au pair will attend the language courses specified above for the duration of the au pair hosting:Language courses3Law of 24 February 1984, Article 3: "In administrative, contentious or non-contentious matters, and in judicial matters, the French,German or Luxembourgish languages may be used, without prejudice to special provisions concerning certain matters.”I-7

Article 6.Tasks of the young au pairThe law of 18 February 2013 on the hosting of young au pairs, as amended in 2018, provides that the youngau pair participates in family related tasks at a rate of 25 hours per week. The main tasks include the supervision of children, but may also consist of light housework, especially related to the children of the host family.You will find a list with examples of tasks in accordance with the law under Annex 1 hereof.In order to avoid any misunderstanding and subsequent inconvenience, it is strongly recommended that thehost family decides together with the young au pair what tasks he or she will have to carry out during their stayand to record them in this au pair agreement.The young au pair undertakes to participate in light daily family tasks, in particular:List of tasksArticle 7.Projected weekly scheduleThe law of 18 February 2013 on the hosting of young au pairs, as amended in 2018, provides that the youngau pair participates in family related tasks at a rate of 25 hours per week. The duration may not exceed anaverage of five hours per day over a period of one week. The weekly duration may not exceed twenty-fivehours on average over a period of one month or four weeks.In this respect and in order to organize the young au pair’s stay, the parties have, prior to the hosting, drawnup together a weekly schedule in perfect compliance with the limits provided by the law of 18 February 2013.This weekly schedule is attached hereto and forms an integral part hereof. See Annex 2 heretoI-8

Article 8.Other provisionsThe parties also agreed to the following:Arrangements for the payment of travel expensesAssumption of the expenses related to the residence permitParticipation of the young au pair in family leaveArrangements related to days of restOthersI-9

Article 9.Supporting documents requiredSupporting documents - host familyLess than 3-month-old extendedresidence certificateIssued by the commune of residence.MyGuichet.luLess than 3-month-old criminal recordextract for all family members who are18 years of age or more at thebeginning of the young au pair's stayIssued by the Ministry of Justice.MyGuichet.luEvidence that day-care for childrenunder the age of 6 has been arrangedfor the period of the young au pair'sstayIssued by a childcare facility or a parental assistant;failing this, a sworn statement, a model of which can befound under Annex 3 heretoSupporting documents - young au pairA copy of a valid identity card orpassportA certificate of residence of the currentplace of residenceFailing that, any other proof indicating the current placeof residence (e.g. an invoice)A copy of the certificate ofstudies/degree giving access to highereducation in the country of origin orproof that the applicant has attendedcourses at least up to 17 years of ageThe supporting document attached must be translatedby a sworn translator if it is not in German, French orEnglish.A medical certificate, issued less than 3months before submitting the completedossier to the SNJ, certifying the youngau pair's ability to carry out light routinefamily related tasks, including childcareThe supporting document attached must be translatedby a sworn translator if it is not in German, French orEnglish.The template of a sworn statement can be found underAnnex 4 heretoA sworn statement indicating that thereare no family ties up to and includingthe 4th degree between the host familyand the young au pairThe template of a sworn statement can be found underAnnex 5 heretoI-10

Article 10. Final provisionsThe parties to this contract take note that the law stipulates that: the hosting of an au pair may not begin before this application and the actual start date of the activityof the young au pair have been communicated to the SNJ; the young au pair must have the approval of the Minister responsible for youth and be in compliancewith the provisions of the amended law of 29 August 2008 on the free movement of persons andimmigration; the daily participation of the young au pair in everyday family related tasks cannot be the main purposeof the stay. It may not exceed five hours per day on average over a period of one week; the approval shall be withdrawn if the host family ceases to meet the conditions of approval,respectively the commitments based on which the approval was granted, or when, as a result of itsactions, the host family puts the safety or the physical or mental health of the young au pair at risk.The approval is also withdrawn if the host family does not meet the commitments arising from the aupair hosting agreement; The approval may be withdrawn if the young au pair has resorted to fraudulent practices or has madeinaccurate statements to obtain it. It may also be withdrawn if the young au pair does not comply withthe conditions or the commitments made, to which the granting of the approval was subject; the au pair hosting agreement may be terminated early with immediate effect in the event of forcemajeure or serious misconduct of one of the parties and with at least one month's notice in all othercases. The party who intends to terminate the au pair hosting agreement must inform the other partyin writing and submit a copy to the SNJ. The SNJ will then provide a termination form to be completedby the parties. if the host family intends to terminate the au pair hosting agreement before the term expires, it shall,prior to any decision, invite the party concerned for an interview during which the reasons for thecontemplated decision are explained and the young au pair's explanations are heard. The host familyand the young au pair have the right to request the mediating presence of an SNJ representative,provided that they inform the other party thereof in advance and in due course.I/we, the undersigned, hereby apply to the Minister of Education, Children and Youth for approval as a hostfamily for a young au pair. I/we have enclosed the supporting documents required in Article 9 hereof.I/we have taken note of my/our obligations as a host family listed in Article 3 hereof, to which I/we comply.Signature of parent 1Signature of parent 2 (if applicable)I-11

I, the undersigned, hereby apply to the Minister of Education, Children and Youth for approval as a young aupair. I have enclosed the supporting documents required in Article 9 hereof. I have taken note of my obligationsas a young au pair listed in Article 6 hereof, to which I comply.I undertake to regularly check my e-mail address indicated herein and agree that decisions relating to my stayas a young au pair - the granting of approval, hosting agreement, refusal or withdrawal of approval or any otheruseful decision - will be sent to that e-mail address.Signature of the young au pairThe parties declare that they have taken note of the provisions and information attached hereto.This agreement is subject to a suspensive condition of the granting of the approval of the host family and ofthe approval of the young au pair.Done in onSignature of the young au pairSignature of a representative of the host familyThis agreement is drawn up and signed in three copies, of which:1) one copy will be kept by the host family;2) one copy will be kept by the young au pair;3) one copy will be sent to the National Youth Service.I-12

II.ANNEX 1: FACT SHEET – TASKS OF THE AU PAIRThe law of 18 February 2013 on the hosting of young au pairs, as amended in 2018, provides that the youngau pair participates in family related tasks at a rate of 25 hours per week. The main tasks include the supervision of children, but may also consist of light housework, especially related to the children of the host family.Beneath, you will find a list with examples of tasks that are in accordance with the law.In order to avoid any misunderstanding and subsequent inconvenience, it is strongly recommended that thehost family decides together with the young au pair which tasks he or she will have to carry out during theirstay and to record them in this au pair agreement.Supervision of children Helping children get ready in the morning/evening (help them get dressed, prepare their bags,etc.) Supervising the children when they do their homework Taking the children to and from the nursery, school, etc. Taking the children to their leisure activities or on outings Familiarising children with the au pair’s culture and language Playing with the children on a daily basis Having meals with the children/helping children have their meals Supervising children in the evening in the absence of parents ("babysitting")Light household tasks Washing, ironing, folding children's laundry Making light meals with/for children Running small errands Emptying the dishwasher Tidying up the children's bedrooms Cleaning, tidying up their [au pair] own bedroom and possibly their [au pair] own bathroomII-1

Tasks not to be performed by the au pair, unless the au pair explicitly agrees tothemXCleaning private spaces of the host family (e.g. parents’ bedroom or bathroom)XCleaning the garage, the attic, the basement, car washingXGardeningXDoing laundry for the host familyXPreparing meals for the host familyCAUTION!The au pair is neither a housekeeper nor a professional educational assistant! Generally, the preceding tasks should not be performed by the young au pair, unless explicitly agreed upon by the au pair.The au pair hosting agreement is the right place to include this arrangement if appropriate. The 25hours per week shall not be exceeded under any circumstances!II-2

III.ANNEX 2: PROJECTED WEEKLY SCHEDULEhours rsdayFridaySaturdaySundayHours per week(max. 25)0.0III-1

The host family together with the au pair develops and fills in the above illustrated “projected weekly schedule”.The schedule will then be signed by both parties if agreed upon. The parties undertake to follow the schedulebest possible. Nevertheless, it is recommended to adapt the schedule at the beginning of each week togetherwith the au pair with regard to any given exceptional weekly chores and appointments. It is also recommendedto put the schedule in a clearly accessible and visible location for everyone to see it. Don’t forget: communication is key.Signature of the young au pairSignature of a representative of the host familyPreceded by the words "read and approved"Preceded by the words "read and approved"III-2

IV.ANNEX 3: SWORN STATEMENT “DAY-CARE”The declarantName et first name:Date o

The young au pair will be hosted in the host family for a period of: From To Duration in months . During the hosting period determined by the family together with the young au pair, the family will ensure that the young au pair can make the most of this opportunity to pursue the main objective of the au pair program,