Domestic Affairs - Exceptional Help For Your Home&Family

PRELIMINARY FAMILY INFORMATION:
Please fill out all of the following information (*Indicates required field):

*First Name:
*Last Name:
*Best Phone number to reach you:
*Email Address:
Home Phone:
Work Phone:
Cell/Pager:
Fax number:
Address:
City, State, Zip:

What kind of help do you need?(Check all that apply):
Nanny Housekeeper Baby Nurse Chef	Personal Assistant House/Estate Manager Houseman/Butler	Full Time Part-Time Live Out Live-In
Approximate start date:

How many children do you have?
Age of children :
Days and hours needed:
Is driving on the job required?	Yes No
If YES, is there a car available?	Yes No
Is cooking required?	Yes No
If YES, for the children only?	Yes No
For the family?	Yes No
Is travel required?	Yes No
If YES, domestic?	Yes No
International?	Yes No
How often?
Briefly describe the responsibilities of the position:
Any additional information on the type of person you are looking for:
Approxiamte salary range:

How were you referred to the agency?
Which search engine did you use?