海外職業介紹契約書.聲明書 (美國aupair專業型)
委託人: (以下簡稱甲方)
立委託書人
受託人: 卓洋國際顧問有限公司 (以下簡稱乙方)
甲方就安排 美國打工 等事宜，委託乙方代為企劃辦理，並提供相關分析資料，經雙方同意有關委託及約定事項如下:
契約期間:自 至 止。
委託辦理事項：美國暑期打工許可之申請及其他相關業務協助。 ■
報名費用:
（一）報名費用：新臺幣壹萬貳仟元整。
（二）申請費用：媒合型新臺幣柒萬壹仟元整/自助型新臺幣伍萬壹仟元整。
備註: □其他優惠________________________________________________________________________
報酬給付之方式、條件與期限。
其他條款：
第一條 保密義務及賠償
乙方因辦理委託契約事項而知悉及持有甲方所提供之必要所有資料，僅供乙方使用於美國暑期打工計畫之計畫範圍內之特定目的使用。乙方違反前項規定者，致甲方受有損害時，乙方應負賠償責任。乙方所收集關於甲方之資料，以電腦處理者，其對外使用該等資料應依電腦處理個人資料保護法規定為之。計畫未完成甲方取消契約時，除甲方屆時另有書面同意外，乙方應將所留存影本 ■
乙方不得有要求甲方購買或推銷商品、加入直銷、招攬及其他類似行為。
第二條 擔保保證責任
乙方違反為辦理本契約約定事項，向甲方所為特殊擔保之義務者，甲方得解除契約，並請求損害賠償。
第三條 廣告效力
乙方應確保廣告內容之真實，廣告中服務內容、品質等所為保證或說明，甲方得據此而為主張。
第四條 協力義務及賠償責任
乙方應告知甲方申請之必要文件內容及其他甲方應盡之協力義務內容，並據以執行。
申請資格、專案期限、內容及其他須由甲方提供申請之必要文件，或應由甲方辦理之手續，甲方應配合提供及辦理，若因可歸責於甲方事由，致無法完成契約委託事項者，乙方不負賠償責任。
第五條 參加專案之相關條件及風險，應善盡告知義務。
第六條 乙方說明義務
乙方對於海外機構提供之資料、DS-2019核發、簽證申請及其相關問題與風險，應盡說明之義務。乙方對於甲方申請專案有關退費等相關規定，亦應盡說明之義務。
第七條 委託事項不能完成及賠償責任
甲乙雙方之任何一方，得隨時終止本契約。
依前項規定終止契約，致他方遭受損害時，應負損害賠償責任，但因不可歸責於該當事人之事
由，得終止契約者，不在此限。甲方依前項規定應負損害賠償責任時，其賠償金額不得超過所須
支付費用之總額。相關退費事宜，依照專案報名表、聲明書及退費規定為主。
第八條 不可歸責當事人事由致事務不能完成
因天災、戰亂、罷工、交通阻絕、政府命令或其他，乙方應即時為必要告知，且不可歸責雙方之任何一方事由，致契約事務不能完成，扣除必要規費及行政規費後其餘退還，甲方尚未繳納款項得免支付。
第九條 任意終止與報酬(應以書面告知為準)
甲方得於乙方完成委託事項前終止本件委託與授權，除已發生之委託報酬費用仍應依契約給付外，乙方依下列原則退還餘額。
第十條 其他退費規定:
呈上項，欲取消專案者，必須於AIT面談後4個工作天內提出申請，並附上拒簽證明文件、返還DS2019表格。
第十一條 上述退費情況發生時，均需自行負擔海外及國內銀行手續費。
第十二條 本公司依勞動部規定投保新台幣貳佰萬履約保證金。
第十三條 本委託書所載全部條款內容，業經乙方詳實說明，並由甲方逐條、充分審閱、考慮並確認(或於簽訂
本委託書前5日攜回審閱)完成，雙方均無異議。(確認簽名: )
第十四條 法院管轄:因本契約約定事項訴訟時，雙方同意以高雄地方法院為第一審管轄法院。
第十五條 本契約書一式兩份，甲乙雙方各執乙份。
立契約書人
甲方（委託人）:
國民身分證：
電話：
地址：
簽約顧問:
【美國au pair打工計畫】
1. 美國au pair打工為美國政府交換計畫之一，持J-1簽證，提供給各國青年以照管孩童方式在美打工旅遊，家庭將提供一整年食宿及薪水做為回饋。2. 此專案必須經由美國及台灣委託指定機構辦理，才能合法入境。 3. 參加者資格:(1) 需年滿18歲至26歲且非美國籍。(專業型需年滿20歲)(2) 須提供高中以上的最高學歷畢業證書。(3) 具備12歲以下兒童照顧經驗，須有至少2份兒童照顧推薦信(非親戚關係)，須提供照顧經驗共計200小時以上的時數證明。(4) 提供至少1份自我特質、態度等的朋友推薦信(非親戚關係)。(5) 具備基礎英文溝通能力，並且通過英文筆試及口試、心理測驗。(6) 健康狀況良好、有耐心愛小孩、不抽菸、獨立自主及對美國文化有興趣者。(7) 有駕照且有實際上路的經驗。(8) 專案期間一年，可再延長6個月至1年(詳見4.)(9) 專業型需提供相關教育背景或工作經驗證明4. 機構提供延長簽證文件，若延長期間需出入境美國，則須回台辦理簽證，機票費及簽證申請費需自行負擔。5. 本計畫並非以賺錢為目的，係以文化交流及學習為重，工作也非為個人學以致用的技能訓練為主旨，所以工作性質及地點是不能完全符合個人喜好與需求。6. 入境美國後，須申請社會安全卡，並依規定日期登錄及更新SEVIS系統，否則將終止計畫，嚴重者將被遣送回國，並影響往後的赴美簽證。7. 美國政府有權更動計畫內容，無需事先告知；如因天災、疾病或戰爭等不可抗拒之因素，而導致計畫終止，本公司無須負擔因以上情形所引發有關個人、財產或其他責任問題。8. 合法工作日期依DS-2019(合法文件)上載明為準。任何早或晚於計畫日期皆屬非法行為。工作日期以學員與雇主事先達成共識後，載明於合法文件DS-2019。9. 本計畫係並非遊學團、語言進修或觀光，需個別出發，在美期間的遊程及保險，都是自行安排的。專案期間的協調、更動、申訴、返台後的報稅都需要學生親自處理，而非委由父母、親友或師長代為出面，只能從旁協助，否則本公司概不受理。參與美國au pair打工的同學，皆已屬成年人。因此，需承擔成年人所有責任，並對自己負責。若獨立性不足的學生，請勿嘗試。10. 參加計畫前及計畫期間，參加者應負責取得父母(監護人)同意參加計畫的許可，與父母溝通是學員的責任。GTEC無權干涉與解決家庭事務。【專案福利 】
11. 福利依專案類型不同而異，詳情請參閱專案類型參考表。12. 赴美國機構(AP4M)4天3夜職前訓練(包含住宿費及早、午餐/晚餐須自理)。美國機構(API)線上職前訓練。(依媒合到的家庭所屬機構而異)13. 台灣至美國國際段來回機票。(專案須完成一年，未完成者須自行負擔回程機票)14. 抵達當地後，前往接待家庭之交通費用。15. 工作期間薪資最低美金195.75 元/週及免費三餐及住宿。(依專案類型不同而異)16. 在美工作期間醫療保險。17. Au Pair 聚會及當地輔導員(LCC)協助18. 提供500-1000美元至當地大學修習6-12個學分課程。(依專案類型不同而異)19. 一年提供14天有薪假。在第一個月過後，會每個月賺取一天的有薪假，若有換新的家庭而先前有未使用的有薪假，一天有薪假可以從先前的家庭兌換35美金。若有預先支用假期但之後未完成工作補回，則需以一天35元美金的方式計算，補償家庭。【工作】
20. 通過英文測驗表示符合參加計畫的資格，不保證一定能媒合到雇主家庭，雇主僱用與否均有自己的考量。21. 所有申請文件上傳後，至少需2至6個月以上的媒合期間，並不能保證一定會在預計出發時間媒合到雇主家庭，若因個人因素延後文件上傳時間，則媒合時間必須往後順延，申請者請自行負責。22. 申請的資料請依照線上教學提供，照片、影片規格及呈現方式需依照教學及本公司要求調整。21.雇主會依每位學員的到職日、申請文件等內容，決定是否面談，面談過後由雇主決定是否錄取。22.學員須在雇主家庭面談過程中，自行與雇主討論赴任日期、工作內容及雇主提供的薪資等條件，雙方達成協議後，美國機構會提供契約給雙方簽名。請注意:從雇主確認雇用到申請簽證至少需1個月。23.學員計畫資格一經取消，本公司概不對學員負任何法律上之義務與責任及任何財物的損失。24.工作期間:每日工作不超過10小時，每週工作不超過45小時，請自行與雇主確認每週工作時數。(學分型每週工作不超過30小時) 25.薪資條或是任何單據皆收齊整理好。請在離開前，與雇主確認台灣的地址，確保最後一筆薪水，用支票的方式寄送給妳。離開美國前的一個星期，請關閉銀行帳戶，且領取剩下的餘額，以免會有管理規費的產生或是倒扣的現象。26.參加學員於看雇主資料時有責任與父母一起討論。家長應對工作許可內容與學員工讀期間法律行為之同意，以避免法律爭議；雇主與學員本人之間的聘僱關係本公司無法干涉，亦不屬本公司的諮詢範圍。日後學員不得因與雇主之糾紛要求退費或負擔任何法律責任。27.每個雇主都有不同的工作條件及僱用標準，你的雇主因喜歡你的履歷、影片，而願意提供工作許可讓你獲 取J1簽證，學員應秉持尊重對方的態度，與對方溝通協調以降低文化的落差、盡可能地適應不同的生活及工作環境，以文化交流為主要目的，請勿與其他學員比較工作或住宿條件，你也可利用連絡美國機構，請機構給予建議，或參考本公司常見問題。28.雇主家庭提供餐食、住宿環境等資訊，請跟雇主面談時自行評估及確認。29.抵達雇主家庭的四十八小時內美國機構專員會聯絡雇主家庭。並在抵達的兩個星期內拜訪家庭。在這計劃執行的一年中，我的雇主家庭將會需要出席美國機構所舉辦的兩次家庭會議日至少一次。30. 雇主家庭保有以下兒童照顧要求的權力而學員必須同意以下:－當孩子因為生病請假在家，我必須也在家照顧孩子－當家長晚上或是整晚不在家時，我必須在家照顧孩子31.Au Pair 如果中途和接待家庭出現問題，先學習與家庭父母溝通，自身是否有盡職或者家庭要求超出照顧孩童工作範圍? 也可請求輔導員協調，如果問題仍無法改善，美國機構可協助更換家庭。在重新配對的過程中你需要同意和美國機構完全的合作。如果美國機構無法幫你找到合適的新家庭，你可能會被遣送回國並且需要自行負責費用。32.計畫結束前3-4個月，機構會詢問是否要延長專案，延長專案期間以原接待家庭為優先。需有合理之理由及因素，經由機構同意，尚可申請更換接待家庭(無法保證媒合期間及無縫銜接)。
【保險】
33.提供工作期間醫療保險，若延長專案，無須額外支付費用。34.醫療保險只保意外事故，不包含計畫開始前已有的舊疾復發之醫療給付，如有心臟病、氣喘、過敏等慢性病、遺傳性疾病或出發前，發生的傷病者，須慎重考慮自己身體狀況，並自行負責。
【費用】
35.本計畫費用包含項目為文書處理費、測驗費、機構開通費、文件審閱及機構專案費等。36.學員應認知需自行負擔護照申請、美國簽證費、良民證申請、體檢費用、駕照申請、SEVIS、旅遊期間保險、旅遊、交通、住宿、生活，甚至是再次申請簽證費用、或更換工作等其他因本計畫所產生之費用，請衡量經濟狀況，同意後才報名。若有任何航班上的額外支出或是更改費用皆需自行支付。37.在計劃結束前的最後兩個月，學員需要通知美國機構離境時間跟相關資訊並且預先支付任何有關機票上的費用，若沒有依照前述所執行，我將需要自行安排航班以及繳付任何罰金、費用。38.學員必須完全遵循J-1 簽證規定下才會被支付回台機票，以下事件發生時需自行支付費用:①. 我施暴兒童、忽視或是因自身不當的行為而造成孩童生理上受到傷害②. 在美國時我更改J-1簽證之身分③. 未經過允許在寄宿家庭的家中吸菸或是自行使用汽車④. 因吸毒或是過度飲酒對工作有不良影響或是我在工作期間吸毒或是過度飲酒⑤. 未滿12個月便離開或解除計劃⑥. 我沒有完成我的教育學分⑦. 在計畫執行中，我沒有每個月和當地專員聯繫
【個資使用同意聲明】
39.依照個資保護法及依民法第195條隱私權之保障規定，請詳細閱讀下所載內容，當您完成計畫申請表填寫並簽名時，表示您同意所載事項。甲、 本人所檢附的申請資料：姓名、護照英文拼音、性別、國籍、身份證字號、出生年月日、連絡電話、行動電話、永久地址、E-mail、身份別、就讀學校名稱、科系名稱、年級、畢業年限、照片、緊急聯絡人(姓名、關係、聯絡電話、行動電話、通訊地址)、英文履歷、影音、申請文件參加過J-1計畫之資訊，僅供GTEC使用於美國打工計畫之計畫範圍內之特定目的使用。乙、 個人資料處理、利用及/或國際傳輸之期間、地區、對象及方式：a. 期間：本人申請GTEC計畫前階段(如申請、審核階段)、計畫進行期間、依法令規定之保存期間、經本人明示同意之期間(以孰晚屆至者為準)。b. 方式及地區：包括書面、音軌紀錄及或電子等形式，於境內境外網路平台之地區。c. 對象:GTEC、美國機構、計畫相關第三方(如雇主、房東、保險公司、報稅服務公司)。丙、 本人瞭解所提供之個人資料，假如經由檢舉或GTEC發現有不符真實身分或有冒用、盜用其他個人資料，資料不實等情事經查證屬實時，GTEC有權取消本人當次參加資格及未來申請資格。40.依據個人資料保護法，非學員本人，恕本公司不予透露學員個人資料給學員以外之第三方，計畫期間學員有義務親自瞭解計畫內容與過程，並有責任告知家人，獲得支持及同意。41.參加學員本人同意GTEC使用與學員相關之任何書面、照片或電子等形式之資料，以推廣此文化交流計畫。
【其他】
42.GTEC/美國機構/雇主等計畫相關對象，無論以Email或電話等與學員聯絡，學員有義務主動回覆Email或電話聯繫，並隨時注意Email信箱，學員至少每個月需聯絡機構一次，學員若失聯，機構將視為違反規定，計畫終止、遣返回國、你也可能被罰款，並影響往後的赴美簽證。43.確認工作前後，參加學員需親自事先瞭解各項資料與規定，清楚工作與住宿條件、瞭解抵美後的交通工具與報到方式，以上如遇疑問，應主動聯絡雇主，以避免狀況不明瞭，日後產生不必要的誤會。亦不得事後以不清楚為由向本公司提出更換工作或退費等要求。
AU PAIR AGREEMENT
I , , as a participant of the Au Pair 4 Me educational and cultural exchange program, as Standard Au Pair, understand and agree to the following terms and conditions relating to the au pair’s participation in Au Pair 4 Me au pair program.
1. I agree to:a. Carry out my responsibilities in child care for my host family’s child(ren) in a conscientious and alert manner with respect, courtesy, safety and commitment;b. Obey all U.S. federal, state and local laws;c. Act with a level of maturity which is respectful of my host family’s values;d. Avoid behavior which may reflect negatively on my host family or Au Pair 4 Me;e. Actively participate in and contribute to the life of my host family with a positive attitude, as if I were a member of the family, and join in family meals, holidays and other cultural and social activities;f. Cooperate fully with all Au Pair 4 Me representatives and comply with any instructions they may give me;g. Use good judgment, sensitivity and caution while participating in the Internet-based communities and social networking websites,such as MySpace, Facebook, YouTube etc. I agree not to post host family’s photos or personal information, including but not limited to, addresses, phone numbers, names, and any other information on any website, blog or the like without the express written consent of my host parents.
2. I agree to comply with the program regulations issued by the United States Department of State (22 CFR Part 62). I acknowledge receipt of a copy of those regulations as they apply to me. I also understand that I must comply with Au Pair 4 Me rules as outlined in this agreement, the Au Pair Handbook and other materials that Au Pair 4 Me has supplied to me. This includes staying within the legal number of working hours per day and week without exception. This also includes participation in all child safety and child development training and orientation sessions sponsored by Au Pair 4 Me. I will inform my local coordinator or Au Pair 4 Me office if I encounter anything that does not comply with the au pair program regulations as outlined by the U.S. Department of State Regulations.
3. I acknowledge that any materials, forms and documentation I submit to Au Pair 4 Me will be used to make a suitable host family match for me and therefore agree that any submitted materials may be disclosed to prospective host families during the selection process.
4. I understand:a. That I must be contacted by a potential host family a minimum of two times by telephone/Skype prior to an agreement to match;b. That I cannot be placed with a host family who has children under the age of 2 unless I have a documented childcare experience with children under the age of two (at least 200 hours, non-family related);c. If I cancel the program after having accepted a host family placement, I will be responsible for reimbursing Au Pair 4 Me for the international airfare fee of deposit fees and visa;d. That during the first three (3) days of my stay with the host family, a parent or another responsible adult shall remain in the home to facilitate my adjustment into the family, household and community. Failure of this condition by the host family will be immediately reported to Au Pair 4 Me and the Local Coordinator;e. Au Pair 4 Me Local Coordinator will contact me and my host family within 48 hours of my arrival to my host family. I also understand that Au Pair 4 Me Local Coordinator will visit me and my host family within two weeks of my arrival to my host family. My host family will also attend at least one of two family day conferences sponsored by Au Pair 4 Me during the program year;f. I am required to be in contact with the Local Coordinator every month. If I do not hear from the Local Coordinator in any givenmonth, I will notify head office by email that the Local Coordinator has not contacted me. If I fail to communicate with the Local Coordinator each month and in a timely fashion, I may forfeit my paid airfare home and have to pay for my own transportation back to my home country;g. I am not responsible for looking after a baby who is younger than three (3) months old, and will notify my Local Coordinator if I amasked to do so;h. I am not responsible for caring for a special needs child unless I have been properly notified before matching and have the appropriate background for caring for the special needs child, and will notify my Local Coordinator if I am asked to do so;i. That Au Pairs are entitled to two weeks of paid vacation. In case of rematch, an au pair who did not receive any days off by the time her/his current placement ends will be entitled to those vacation days once placed with the new host family. If an au pair received some or all vacation days, she/he will not receive more than 2 weeks total during the 12-month program.j. If I travel outside of the U.S. during the one-year program term, it is my responsibility to contact the appropriate country’s embassyto determine if a visa is required for my entry into that country;k. That if I commit any violation of this pledge and agreement, I may be financially responsible for any monetary penalties incurredas a result of my conduct.
5. I agree to perform the child care responsibilities as outlined by Au Pair 4 Me and my host family to the best of my ability. I understand that providing childcare is my primary obligation in the au pair program and that any personal plans or activities will take secondary priority to caring for my host children. Should I be found to act in a way that puts my host children at risk or is inappropriate in any way, I understand that I will be removed from the au pair program immediately. I understand that my host family may ask me to respect a curfew and/or assign other reasonable restrictions designed to protect the safety and well-being of my host children. I understand that my childcare duties must be related to the children of the host family and they may include the following: cooking for the children; washing dishes after children; cleaning children’s room; doing children’s laundry; transporting children; teaching children; supervising playtime, etc. If I am asked to perform services that are not childcare related, or if I am asked to care for another family’s child(ren), I will notify my Local Coordinator.
6. 45-HOUR AGREEMENT FOR THE HOST FAMILY AND AU PAIR. The au pair program regulations, issued by the United States Department of State, require that a written agreement between the au pair and the host family outlining that the au pair is not to provide more than 10 hours of child care on any given day, nor more than 45 hours of child care in any one week has been signed by both. The au pair and host family hereby agree to limit the number of hours the au pair is obligated to provide childcare services to not more than 45 hours per week and to limit the number of hours the au pair may provide childcare on any given day to no more than 10 hours. I understand that I will be compensated at a weekly rate based on 45 hours per week and paid in conformance with the requirements of the Fair Labor Standards Act. I will receive a minimum of one and a half days off per week, in addition to one complete weekend (Friday evening until Monday morning) off each month. Furthermore, I will receive two weeks of paid vacation to be taken at a mutually agreed upon time during my program.
7. In addition to the terms of my au pair responsibilities, I understand that I have certain responsibilities toward my host family as a whole, and I agree to:a. Maintain my bedroom in a clean and orderly fashion;b. Contribute to the cleanliness of the shared areas of my host family’s home, including but not limited to areas such as bathrooms, living rooms, kitchens, etc.;c. Openly communicate in advance with my host family regarding the scheduling of my free hours and two weeks of vacation;d. Promptly reimburse my host family for any and all expenses they may incur on behalf of my personal needs such as telephonebills, etc.e. Respect the curfew and house rules regarding guests;
8. I understand that I may not use the family’s automobile(s) for any reason without express permission from the host family and that any agreement to use the host family’s automobile is strictly between the host family and me. I will not use the automobile unless the host family has obtained all of the mandatory automobile insurance coverage required under the laws of the state where the host family resides. I understand that if I have a car accident while using the car for personal use not related to my child care duties that I will be liable for one half the damages up to $500.00 per accident for any injury to the car that occurs when it is under my control.
9. During my one-year program stay in the U.S., I will not under any circumstances:a. Accept any form of paid employment other than for my duties as an au pair with my host family from whom I will receive a weekly stipend according to the current U.S. Government regulations;b. Ask to borrow money from my host family or accept any offer from them to lend money to me;c. Use illegal drugs or engage in the excessive use of alcohol during my stay;d. Consume alcoholic beverages if I am under the U.S. legal drinking age of 21 years old;e. Smoke in the home of my host family without permission;f. Violate the terms jointly established in the Host Family-Au Pair Agreement;g. Engage in any form of sexual misconduct.
10. I understand that Au Pair 4 Me has the exclusive right to determine my suitability for acceptance and for my continued participation in the au pair program. I understand that if Au Pair 4 Me determines that my emotional or physical state does not make me suitable for providing quality childcare, I will be removed from the program. I also understand that should I marry or become pregnant while on the program I will also be removed from the program. If my performance as an au pair and/or participation in the program is deemed unsatisfactory by Au Pair 4 Me for whatever reason, Au Pair 4 Me will reassess my suitability for future placement. I understand that I may be terminated from the au pair program if I do not successfully complete the program requirements and uphold program expectations for reasons including, but not limited to, the following: leaving the host family without prior consent from Au Pair 4 Me; engaging in behavior that Au Pair 4 Me deems inappropriate during the program duration, performance reasons including but not limited to breaking host family rules, neglectful or inappropriate behavior towards the children, etc.; non-participation in training, not fulfilling educational credit, not maintaining monthly contact with local coordinator, or if I in any way violate this agreement. I further understand that should it be discovered that I have falsified or withheld critical information from my application materials including, but not limited to, health conditions, criminal history, educational documentation, childcare experience, etc. I may be terminated from the au pair program. Should I be terminated from the program because of my actions including, but not limited to, those outlined above, I forfeit my return flight ticket to my home country and must pay for this flight on my own.
11. I attest that I have chosen to enter into the Au Pair 4 Me program of my own free will, and I have done so with the intent of personal, educational and cultural enrichment, and I agree to:a. Enroll and attend an accredited U.S. post-secondary institution for a minimum of 6 credit hours or its equivalent. I understand my courses shall be taken at mutually agreed upon time with my host family. I understand my host family shall pay tuition up to a maximum of $500 for the year. I will submit verification of attendance for these classes at the end of my program year;b. Pay for my educational expenses that exceed the $500 financial assistance provided by my host family;c. If I change host family mid-year after I have already received an educational contribution, I will not be eligible to receive more than a total of $500 from all families. I have read and agree to all of the terms regarding education stipend during the rematch process included in the Au Pair Handbook;
12. Pledge of Commitment and Cooperation - In exchange for Au Pair 4 Me accepting me for the au pair program, I solemnly pledge to:a. Present myself honestly in all correspondence and documentation with the Au Pair 4 Me and all its representatives as well as my host family; I pledge not to falsify any documentation;b. Notify Au Pair 4 Me immediately of any new information and/or changes to my application;c. Accept whatever host family location Au Pair 4 Me may arrange for me in any area in the U.S.;d. Attend all required orientations, training and supervision meetings as well as complete periodic program evaluations and training materials;e. Complete all visa requirements as instructed, and be responsible for obtaining a valid passport;f. Comply with all vaccination and immunization requirements, undergo a thorough medical examination and provide all information requested on the Au Pair 4 Me medical form;g. Be present in sufficient time for transportation provided or arranged by Au Pair 4 Me. I understand that Au Pair 4 Me is not under any obligation to provide alternative transportation, except in the case of illness or accident in accordance with the group insurance policy;h. Make arrangements and pay for my transportation to and from my home country airport prior to my departure to the U.S. andupon my return to my home country;i. Make arrangements and pay for my transportation to the U.S. international airport at the end of my program year.
13. I agree to pay any personal expenses I incur while participating in the au pair program, including but not limited to, health expenses not covered by insurance, phone bills and/or car damages. Au Pair 4 Me is not responsible for any financial disputes I have with my host family such as outstanding money for educational component, weekly stipend, etc. I understand that I must settle all disputes directly with my host family prior to my departure from their home.
14. I understand that the au pair program is designated as a full year program with the possibility to extend for a further six (6), nine (9) or twelve (12) months. Should I voluntarily decide to return home before the regular end date of my program (including extension period) I understand that my flight will not be paid for by Au Pair 4 Me. The exception to this will be in cases of my own extreme illness. Should I terminate or be terminated from the au pair program for any reason as outlined in this agreement, such termination will result in the following:a) I will forfeit the return ticket and I will be required to make my own arrangements to return to my home country at my ownexpense; b) My Au Pair 4 Me insurance coverage will no longer be valid; and c) My status will be reported to U.S. Immigration and my participation in the au pair program will be canceled. d) Au Pair 4 Me will not provide me with housing in the USA.
15. End of the au pair year – I understand:a. That I must return to my home country no later than 30 days after the last day of my one-year program term (date indicated on my DS-2019 form). The J-1 visa allows for this 30-day grace period for exchange visitors to return to their home country. During this 30-day grace period the host family is not required to host the au pair nor are they required to pay your weekly stipend amount;b. That medical insurance provided by Au Pair 4 Me is valid for 366 days from my arrival in the U.S.; Au Pair 4 Me will purchase medical insurance coverage for the 13th month if I choose to remain in the United States for the one-month (30 days) grace period;c. That I am responsible for any applicable airline surcharges or fees resulting from changing or canceling my travel itinerary;d. That two months prior to the end of the program year, the au pair is required to notify Au Pair 4 Me, in writing, of his/herdeparture itinerary and pay any applicable airline charges in advance. Should the au pair fail to comply with this request, the au pair is responsible for arranging the departure flight and paying any penalties, surcharges, and/or ancillary expenses related to non-notification.
16. Grievance Procedure and Resolution. Should significant problems occur, including but not limited to my health, safety or welfare and/or adjustment to the family, culture and language, I understand the following actions will take place and my responsibilities in such situations:a. The au pair is to initially communicate and problem-solve by working toward a solution with the host family;
b. If the problem persists, the au pair must notify Local Coordinator of the situation. Local Coordinator will intervene and attempt to resolve the problem. The au pair is aware that there is an initial adjustment period of 2 months following the au pair’s arrival before any placement changes are considered; however, any decision regarding the au pair's program status, dismissal or replacement will be made at the sole discretion of Au Pair 4 Me;c. A change in host family needs is not the sole reason for the au pair to request a placement change and/or rematch. The au pairunderstands the nature of the program of being flexible and agrees to cooperate with Au Pair 4 Me during the rematch process;d. If the au pair does not make a good faith effort to resolve the problems or misunderstandings, or if the au pair violates any termsof this agreement, Au Pair 4 Me may in its sole discretion terminate the au pair’s participation in the program and immediately repatriate the au pair to his/her home country at the au pair’s expense;e. If the au pair does not successfully complete the program year, the au pair is responsible for his/her return travel expense;f. If the au pair’s first placement is not successful, and Au Pair 4 Me determines and approves that the au pair shall be placed in a new family, the au pair agrees to cooperate with Au Pair 4 Me during the entire rematch process;g. The au pair will have two weeks to find a new host family. During that time, the au pair can stay with the current host family who, in its discretion, may request the au pair to provide, or not to provide, any childcare services. If the au pair does not perform childcare duties during the rematch process (even if the au pair is staying with a host family), the au pair will not receive the weekly stipend.h. If the host family is willing to house the au pair in transition until he/she is rematched, and Au Pair 4 Me, in its sole discretion, determines that under the circumstances it would be reasonable for the au pair to remain in the home, but the au pair refuses to stay with the family, the au pair will be required to pay a $50.00 per day housing stipend to the party who houses him/her;i. If Au Pair 4 Me is unable to place the au pair in a new family within a 14-day period, the au pair may be sent home at his/her expense;j. Au Pair 4 Me is not responsible for any financial damage or loss alleged to arise from the unavailability of a replacement host family;k. In the event of an accident or serious illness or medical condition that prevents the au pair from continuing his/her duties, Au Pair 4 Me, at its sole discretion and judgment, will end the au pair's program early and expects him/her to return home.
17. Miscellaneous Representationsa. I promise that the information I have given on the Au Pair 4 Me application form, which was completed by me, is truthful and accurate.b. I understand that Au Pair 4 Me, its affiliates, agency and employees will act on my behalf in arranging certain transportation andother services for me during my participation in the au pair program. I understand that none of them will be under any liability to me for any loss, damage, personal injury, delay or expense suffered or incurred by my resulting from any act or omission of any carrier, any member of the host family or any other corporate or non-corporate entity in relation to transportation to and from, and within the U.S.c. I am fully aware that my failure to abide by any of the guidelines and rules stated in this agreement will be grounds for my dismissal from the program, and I will be subject to immediate return to my home country on my own expense.d. I further agree that Au Pair 4 Me or its affiliates or agents may, without liability or expense to themselves, take whatever action they deem appropriate with regard to my health and safety and may place me in a hospital for medical services and treatment, or if no hospital is readily available may place me in the hands of a local medical doctor for treatment.e. I authorize the Au Pair 4 Me to post my photographs and profile on the Internet for the purpose of matching me with a qualified host family.f. I understand that Au Pair 4 Me reserves the right to terminate my participation in this program if I should violate any program rules and/or if my mental and/or physical health, as determined solely by the Au Pair 4 Me, is in jeopardy.g. It is agreed that the U.S. law shall apply to this agreement, and I agree to submit to the jurisdiction of the State of Arizona courts.I have read this entire agreement carefully and I have had the opportunity to ask questions, obtain advice as to its meanings,and I understand it. I am capable of reading and understanding this agreement in English.
18. I understand and agree that the terms and conditions set forth herein, on the Au Pair 4 Me website, in the Au Pair 4 Me materials and au pair handbook shall constitute part of this agreement with Au Pair 4 Me. If a term is found to conflict among the documents, this agreement is controlling, provided however, that the definition of the term is not required by law or U.S. Department of State regulations.
19. I understand that if I stay in the United States beyond the 30-day grace period from the date issued on my DS-2019 form (i.e. deliberately miss my plane connection or choose to stay in country without taking the proper steps) I will suffer the following consequences:• Au Pair 4 Me will file for a termination of the DS-2019 which means the au pair is officially an illegal alien;• All visa violations are reported to the Homeland Security Department and are entered into their systems; thus if a person applies for a driver’s license or credit card or is checked by customs/immigration at the airport, by a police department or other places they will be reported as being an illegal alien;• Once apprehended, the non-returnees will be placed in a detention center until they can be returned to their home country. If they do not have the funds to pay the ticket, they will remain in detention until a family member can provide the funds for the return airfare. They are also deported back to the U.S. Embassy in their home country. Once back in their native country, non-returnees are denied the opportunity to receive a visa to the United States ever again. The same may reflect on their family members.
20. I agree to irrevocably, unconditionally, and fully remise, release and forever discharge Au Pair 4 Me and its affiliates; and said persons’ respective officers, directors, successors, assigns, attorneys, insurance companies, agents, employees and affiliates, or others to the extent acting or purporting to act on the afore mentioned persons’ behalf (all of said persons hereinafter, in the aggregate, being referred to as “Released Parties”), from any and all claims or causes of action which I have or may hereafter have, which arise out of illness, injury, damage or loss of any other kind to me or my property resulting from or during participation in the Au Pair 4 Me program. This includes, without limitation, my performance of services for and involvement with the host family, regardless of how such illness, injury, damage or loss may arise. I further agree to indemnify and hold harmless the Released Parties from and against any losses, claims, damages or liabilities related to or arising out of my participation in the Au Pair 4 Me program, including (without limitation) any illness, injury or damage to me, that my host family causes, that any third party causes, that I cause or to which I contribute, and any illness, injury or damage to my host family which I cause or to which I contribute.
21. My signature on this agreement indicates acceptance of this agreement and is legally binding. No alterations to the terms of this agreement will be valid unless approved in writing by Au Pair 4 Me. If any provision of this agreement shall be deemed unenforceable, such paragraph shall be omitted and the remainder of the agreement shall be valid and enforceable to the fullest extent allowed by law.
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