Hampton Domestics will help experienced and qualified applicants obtain a position. If you feel you are well qualified, you may submit the on-line job application below. You must meet our minimum requirements. We respect your privacy. This information will not be shared with anyone. All of the information requested on this form is provided by you voluntarily. All that we require to contact you is your name and a telephone number. Hampton Domestics is an equal opportunity employer. You may submit this form on-line, or, if you are concerned with the security of transmitting private information over the internet, you may print this form out either before or after you complete it, and then fax it to (631) 725 - 6225. If you print it out and fax the form in, you may use free space as you choose. General Information Name:  Address:    City:  State / Province:    Postal Code:  Country:  Email address:  Home Telephone #:  Work Telephone #:  Other Telephone #:  Date of Birth:   Age: Are you a US Citizen? Yes   No If no, do you have: Green Card   Work Authorization Permit Position Please select one position for which you are most qualified and experienced. References will be required. Baby Sitter Baby Nurse Body Guard Butler Chauffeur Chef / Cook Companion Couple Elderly Care Estate Manager Event Staff Gardener Governess Home Health Aide House Manager House Sitter Housekeeper Houseman Ladies Maid Laundress Major Domo Mother's Helper Nanny Personal Assistant Personal Security Personal Trainer Social Secretary Vacation Home Staff Valet Yacht Staff Yardman Looking For: Live In Live Out      Part Time Full Time Salary Expectations: $ Hourly Daily Weekly Yearly Are you willing to relocate? Yes No If yes, are there any relocation limitations or desires? Previous Employment Record Employer 1:  Address:    City:  State / Province:    Postal Code:  Telephone #:  Country:  Date Started: Date Left: Starting Salary: Ending Salary: Your Title:  Why did you leave this position? Employer 2:  Address:    City:  State / Province:    Postal Code:  Telephone #:  Country:  Date Started: Date Left: Starting Salary: Ending Salary: Your Title:  Why did you leave this position? Employer 3:  Address:    City:  State / Province:    Postal Code:  Telephone #:  Country:  Date Started: Date Left: Starting Salary: Ending Salary: Your Title:  Why did you leave this position? Employer 4:   (Optional) Address:    City:  State / Province:    Postal Code:  Telephone #:  Country:  Date Started: Date Left: Starting Salary: Ending Salary: Your Title:  Why did you leave this position? If you have a digital photograph of yourself, please send it to us afterwards as an attachment on a separate email. You may obtain our email address from our "Contact Information" page, once you've submitted this form. If we are interested in your experience and qualifications, you will be asked to complete an additional, more detailed form. Some of the above questions will be repeated. By submitting this form, I certify that all facts contained herein are true and complete to the best of my knowledge. I understand that Hampton Domestics acts only as a liaison and assumes no responsibility for any act of employer or employee. I agree not to take any position Hampton Domestics refers me to for which Hampton Domestics is not paid by my new employer or by the agency I am referred to Hampton Domestics by. I agree to keep Hampton Domestics informed regarding my current telephone number and job availability. I agree to notify Hampton Domestics when I accept a position through their efforts and to notify Hampton Domestics if and when I leave that employment.