If you would like Hampton Domestics to help you fill a position, please contact us and we will be glad to help you. If you would like, complete and submit the form below, and we can get started assisting you find an employee right away.

Contact Information Your IP address has been automatically recorded.
IP Address= 54.80.58.121

Employer Name:
Email address:

Should another person be cc'd on correspondence? Yes No
If so, please provide e-mail address of that person:

Home Phone #:		Work Phone #:
Cell Phone #:		Fax #:

Home Address Where Candidate Will Work:
City:
State:	Zip Code:
Cross Street:  (if applicable)

Are there any special directions that are helpful to find the home?

Alternative Address (Mailing or Office):
City:
State:	Zip Code:

---

Position(s) Available What type of Position(s) would you like to fill?

Baby Sitter Baby Nurse Baby Guard Butler Chauffeur Chef / Cook Couple Elder Care Estate Manager Executive Assistant Executive Corporate Staffing Executive Housekeeper

Event Staff Home Health Aide House Manager House Sitter Housekeeper Houseman Lady's Maid Landscape Gardener Launderer Major Domo Mother's Helper Nanny / Governess

Other Personal Assistant Personal Security Personal Trainer Restaurant Chef Senior Companion Social Secretary Vacation Home Staff Valet Yacht Staff Yardman

If "Other", please describe position:


Is this a confidential search?Yes   No

Type of Position:

Live In Live Out

Part Time (under 35 hours per week) Full Time (35+ hours per week)

Long Term (one year or longer) Temporary (less than one year)

Start Date:

End Date: (if applicable)

Is there any other domestic help employed in the house?Yes   No
If yes, please list titles, responsibilities, and schedule:


Is there anyone currently employed in the desired position?Yes   No
If yes, please describe the situation:

---

Schedule Days and Hours Needed:
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday

---

Responsibilities What duties will employee be expected to perform? (check all that apply)

Childcare Driving Children Cooking for Children Purchasing Children's Items Child Related Event Planning Children's Laundry Attending Classes with Children Overnight Care

Managing Family Calendar Homework Help Cooking for Family Meal Preparation Complete Housekeeping Light Housekeeping Personal Shopping Grocery Shopping

Pet Care Family Laundry Scheduling Service Personnel Errand Running Travel with the Family Household Event Planning Computer Work Other

If there are "other" responsibilities, please provide details:

---

Household Environment Please describe your residence (i.e. formal, casual, house, apartment, square feet)


Do you have a pool?Yes   No     Do you have pets?Yes   No
If you have pets, please specify

Will pet care be required?Yes   No

Will the employee be required to travel?Yes   No     If so, how often:

Do you have allergies?Yes   No
If you have allergies, please specify


Do you require a candidate to drive?Yes   No
Can you provide a car?Yes   No

---

Live-In (if applicable)

Detached Cottage   Room in House with Private Bath
Room and Bath with Separate Entrance   Room in House with Shared Bath

Please describe living quarters:

---

Compensation and Benefits

Desired Budgeted Annual Salary Range, Based on Duties and Experience of Candidate:
From:   To:

Or Weekly Range, Based on Duties and Experience of Candidate:
From:   To:

Or Hourly Range, Based on Duties and Experience of Candidate:
From:   To:

Will Medical Insurance be provided?Yes   No

Are any there any other additional benefits that will be offered to the candidate?

---

Search Information

How did you hear about Hampton Domestics?
I am a previous client   Friend   Magazine   Newspaper   Internet   Other

Meeting With Us In Person Can Help Us to Understand the Requirements of Your Position. Are You Interested in Scheduling an In-Residence or In-Office Visit With a Hamptons Domestic Agency Specialist? Yes   No

What Days and Times Are Best to Schedule Interviews for You With Potential Candidates?