| Contact ID |
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First Name |
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Last Name* |
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Email |
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Phone |
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Street |
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City |
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State |
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Zip Code |
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Spouse |
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Spouse Phone |
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Mother’s Place of Work |
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Father’s Place of Work |
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When Do You Need To Hire? |
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What type of Domestic employee do you need? |
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Number and Gender of Children |
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Number of children in home and please list if they are male or female |
Do You Need Permanent Or Temporary |
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If Hiring Live-In Describe Living Conditions Here |
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What type of personality works best with you? |
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Please be descriptive |
Do you need the employee to know how to swim |
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Who will be present during the day? |
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Travel How Often? |
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Explain any overnight shifts or travel required |
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Please Describe Daily Routine Expected of Employee |
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Monday Schedule (Start time – End Time) |
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Tuesday Schedule (Start Time – End Time) |
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Wednesday Schedule (Start Time – End Time) |
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Thursday Schedule (Start Time – End Time) |
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Friday Schedule (Start Time – End Time) |
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Saturday Schedule (Start Time – End Time) |
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Sunday Schedule (Start Time – End Time) |
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If your schedule will vary please explain here |
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Please Describe Specific Cleaning Expectations |
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Amount of Laundry Needed |
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Amount of Cooking Needed |
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Amount of Housekeeping Needed |
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SQ FT of Home |
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List Types of Pets In Your Home |
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Compensation Package Desired |
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Hourly Range And Weekly Range |
Salary? |
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Yearly Salary Range |
Any Special Requests Please Describe Here |
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How Did You Hear About Our Top-Notch Agency? |
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File Upload |
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Feel free to upload a job description or picture of your family |
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