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EMPLOYER FORM

	Employer - Online and Downloadable Form
	Employer Description Name: Date: Address: City: Telephone Number: Alternate Contact Number: Children Information: 1. Name Personality Age Comments 2. Name Personality Age Comments 3. Name Personality Age Comments 4. Name Personality Age Comments Any Pets? If yes, please describe: Is the home near any recreational facilities? YesNo If Yes, please describe: Is the home on a bus route? YesNo How many rooms in the home? Approximate size of home: Any outdoor area? YesNo Will the caregiver live in? YesNo If yes, please select appropriate amenities: Suite Bedroom Bathroom Television Phone Stereo Private Entrance Any other extras? Approximate size of living area? Should the caregiver be a driver? YesNo Should the caregiver be a swimmer? YesNo Additional qualities? Employee - Duties and Expectations Please choose the appropriate responcibility designation ? Childcare PrimarySecondary Household PrimarySecondary Household Expectations Meal Prepartion Breakfast YesNo Lunch YesNo Dinner YesNo Sweeping DailyWeeklyBi-Weekly Washing Floors DailyWeeklyBi-Weekly Dusting DailyWeeklyBi-Weekly Bathrooms DailyWeeklyBi-Weekly Vacuuming DailyWeeklyBi-Weekly Kitchen DailyWeeklyBi-Weekly Children Laundry DailyWeeklyBi-Weekly Parents Laundry DailyWeeklyBi-Weekly Ironing DailyWeeklyBi-Weekly Additional? Childcare Expectations Please describe all child care expectations: Start Date: End Date: Work Hours (Daily)? If part time specify days and hours? Monthly Salary? Medical? YesNo Dental? YesNo Any other benefits? Any additional comments:

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