Premier Domestic Staffing – Domestic Help and Nanny Services
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 Home > Prospective Clients > Request Domestic Help

Request Domestic Help

If you are ready to find a qualified, caring domestic help professional for your home, just fill out the form below. We'll get back to you right away to begin the process of finding the perfect person for your needs. Or, just call us at 800-518-1294, and we'll be happy to answer any question you have. We look forward to helping you!

Name:
Address: Street:

City:

State:

Zip:
Home Phone:
Employer/Occupation:
Work Phone:
Cell Phone:
Email Address:
Spouse's Name:
 
Name: Age: School Schedule: Special Needs:
Does your child or children have any special needs?
If Yes, please explain:
 
Positions Required (Check all that apply):
  Nanny
  Housekeeper
  House Manager
  Houseman
  Chef
  Estate Manager
  Couple
  Butler
  Laundress
  Full Time
  Part Time
  Live-In
  Live-Out
Desired Start Date:
Flexible Start Date?   Yes
  No
 
Compensation (Check all that apply):
Salary: Pay range (gross wages/week). Typical Salary for housekeepers is $125-150 per day.
  $450 - $650
  $650 - $850
  Other
Days required to work:
  Monday
  Tuesday
  Wednesday
  Thursday
  Friday
  Saturday
  Sunday
Describe your hours:
 
Services Required: (Please check all that apply)
  Childcare / Housekeeping
  Carpooling
  Grocery Shopping
  Errands
  Laundry (Family)
  Laundry (Children)
  Housekeeping Only
  Ironing
  Plant Care
  Pet Care
  Basic Cooking
  Elder Care
  Driving
  Other
 
Skills Required: (Please check all that apply)
  CPR
  First Aid
  Life Saving
  Swimmer
  Does employee need their own car?
  Ability to assist with homework?
  Second language preference? If so, which one?
 
Household Information
Is the atmosphere of your home formal, semiformal, or casual?
What is the approximate square footage of your home?
Does your home have a pool?   Yes
  No
Is another adult generally home during the day?   Yes
  No
If so, who?
Do you have any pets?   Yes
  No
If so, give a brief description.
Will employee be responsible for pet care?   Yes
  No
If so, give a brief description.
Do you currently employ any other household staff or cleaning service?   Yes
  No
If so, give a brief description.
 
Benefits Package: (Please check all proposed benefits that apply)
  Paid legal holidays after months of employement? (Most holidays include: New Years Day, MLK Jr. Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Hanikkakh and/or Christmas Day)
  Paid sick days after months of employment.
  Paid vacation days after months or year of employment.
  Overtime pay for working over hours per week.
  Guaranteed salary if the employee is not needed.
  Annual salary review and/or bonus.
  Health Insurance
  Dental Insurance
  Automobile Insurance
  Retirement Plan
  Mileage Reimbursement per mile.
 
For live-in employees, please check the following provided accommodations.
  Private bedroom
  Private bathroom
  Furnished
  Television
  Private phone line
  Private entrance
  Allow visitors when off duty?
  Employee may stay or leave when off duty?
Describe the living quarters:
 
How did you hear about Premier Domestic Staffing?
Personal Reference
Yellow Pages
Web Search?
Which Search-Engine?
Which Phrase?
Are you registered with another agency?
 
Please describe your ideal employee.

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