Household Support Services

When attention to detail counts
877.633.6822
askcindy@optonline.net
Client Contact Information & Service Personnel Request
First Name
Last Name
Email Address
Phone Number
Fax Number
Cell Phone
Street Address
City
State
Zipcode
Does anyone in your family smoke? Yes No
How many adults are there in the home? Life Style
Are there any children in the home? Yes No If so How many?
Is your family expecting? Yes No
If so when?
Are there pets in the home? Yes No If so what kind?
Position looking to fill
Proposed start date
Live In
Live Out
Flexible
Full Time
Part Time
Working Hours If other, what hours?
Salary Offering Per Week Per Day
Do you offer health insurance? Yes No
In addition to English, are there other languages spoken in the home? Yes No If so which?
Responsibilities
Child Care Yes No
Cleaning Yes No
Laundry Yes No
Ironing Yes No
Cooking Yes No
Driving Yes No
Errands Yes No
Other Skills
Athletic Prefer Yes No
Biking Prefer Yes No
In line skating Prefer Yes No
Swimming Prefer Yes No
Please tell us about your family and your position.
Please tell us about your ideal candidate

Ask Cindy Inc.
P.O. Box 475 Scarsdale, New York 10583