Request to Hire Form Your Name First Name: Last Name: Contact Information Email Address: Phone: Phone 2: Phone 3: Best time to contact Address Mailing Address: Address Line 2: City: State: Zip Code: Employment Specifications Preferred Position/Specialization [Select One] Maid Babysitter Nanny Housekeeper Couple Cook Butler Baby nurse Summer nanny Companion Gardener Home attendant Mothers helper Governess Chauffeur Other Description of Responsibilities: Living Arrangements Live in Live out Live in and/or live out Type of Situation Full time Part time Preferred Length of Employment Permanent Temporary Per Diem Weekend Requested Start Date: Estimated End Date: Days off: Salary to be paid Benefits: Employment Criteria Age(s) of Dependents: Child One Child Two Child Three Adults in Household (number): Bilingual Required (list language) Driving Necessary? Yes No Car Available? Yes No Uniform Required? Yes No Separate Quarters? Yes No Additional Help? Yes No Additional Comments Add any additional comments you may have How did you hear about us? Submit
