New Registration Form for Domestic Workers

1
Name/ Nombre of Licensed Service Provider* This field is required.A "service provider" is an independent contractor or house cleaner. Most states do not require a house cleaning license. A business license may be required depending on the city or state that you service or live in. It is the responsibility of the independent service provider to obtain needed licenses.
First Name Primer Nombre
Last Name Apellido
2
Phone Number* This field is required.número de teléfono
Please enter a valid phone number.
3
Do you live in New York?Vives en Nueva York?
YESNO
4
Email* This field is required.Correo Electrónico
example@example.com
5
What is the city or area that you live and work in?* This field is required.¿Cuál es la ciudad o zona en la que vive y trabaja?
6
Do you have a Social Security number or EIN?
YESNO
7
Date of Birth* This field is required.Fecha de nacimiento
8
Address* This field is required.dirección
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
How did you find us?* This field is required.¿Cómo se enteró de nosotros?
Google
Offer Up
Indeed
Craigslist
Instagram
Facebook
Laundromat Flyer
Other Flyer
Other
10
Please list at least 3 references and at least 1 client that you have serviced. We need the names and phone numbers. Please also describe your relationship to your references. * This field is required.Enumere al menos 3 referencias y al menos 1 cliente al que haya atendido. Necesitamos los nombres y números de teléfono. Describa también su relación con sus referencias.
Huge
Large
Normal
Small
Ok
Ok
11
Do you have house cleaning experience* This field is required.¿Tienes experiencia en limpieza de casas? Si o No
YES SíNO
12
Do you have a car?* This field is required.¿Tienes un coche? Si o No
YES SíNO
13
Are you sure you have a car? It needs to be your own car, not one that you can borrow.* This field is required.¿Estás seguro de que tienes coche? Tiene que ser su propio coche, no uno que pida prestado.
YES SíNO
14
Do you have your own equipment?* This field is required.¿Tienes tu propio equipo? Si o No
YES SíNO
15
Do you have access cleaning supplies that you can borrow or buy? Yes or No* This field is required.¿Tiene acceso a artículos de limpieza que pueda pedir prestados o comprar? Si o No
YES SíNO
16
Do you have your own clients? Yes or No* This field is required.¿Tiene sus proprios clientes? Si o No
YES SíNO
17
What days do you prefer to work?* This field is required.¿Qué días prefieres trabajar?
Monday Lunes
Tuesday Martes
Wednesday Miércoles
Thursday Jueves
Friday Viernes
Saturday Sabado
Sundays Domingo
Any Todo
18
Do you prefer Mornings or Afternoons?* This field is required.¿Prefieres mañanas o tardes?
Mornings Mañanas
Afternoons Tardes
Any Todo
19
Do you have a business license?¿Tiene una licencia de negocio?
YES SíNO
20
Referral Agreement* This field is required.Please sign the referral agreement.
21
Damages for Late Cancellation* This field is required.
22
No Poaching Agreement* This field is required.
23
I agree with all of the terms of the referral agreement. Estoy de acuerdo con todos los términos del acuerdo de referencia. * This field is required.Signature, Firma
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