| Client's
Demographics |
| Client's
Name |
|
| Service
Address |
|
| Service
District |
|
| Contact
Phone |
|
| Email |
|
| Number
of Adult (>18) |
|
| Number
of Children (<18) and Ages |
|
| Number
of Pet (dog/cat/other) |
|
| Housing
Size (square meters) |
|
| Service
Requirements |
| Live
- In |
Yes
No |
| Full
or Part Time |
Full
Time Part
Time |
| Part
Time Hours (Mon-Sat) |
|
| Service
Time Period |
1-3
months 3-6
months 6-9
months
9-12
months >12
months
|
| Services
Priority (Choose One) |
Household
cleaning
Washing
and ironing
Baby-sitting
and child care Attending
the aged
Meal
preparation |
| All Services Needed (Choose >1) |
Household
cleaning
Washing
and ironing
Baby-sitting
and child care Attending
the aged
Meal
preparation |
|
Housekeeper
Characteristics
|
| Age |
20-30
30-40
40-50
Not
restricted |
| English
Competency |
Good
English Some
English No
English |
| Housekeeper
Starting Time |
ASAP
1-2
months 2-4
months 4-6
months |
| Preferred
Interview Location |
Service
(Client's) Address American-Sino
Office |
| |
