Simplified Brief Customer Interview Form

Please fill in this form in order to enable us to provide you with the most suitable Domestic Helper / Housemaid for your needs.
Employer Details
Employer's Name:
Employer's Mobile Number:
House Address:
Email Address:
example@example.com
Preferred Language(s):

Other
Family Members Details
Number of Persons to be served:
Number of Adults in the house & their Ages:
(Please specify. Example: 3 adults, ages 31, 52, 55)
Number of Children & their Ages:
(Please specify. Example: 3 children, ages 5, 7, 12)
Key Person(s) to be served, their Age(s) & Gender:
(Please specify. Example: Daughter, age 9, female)
House Type:
If Other, please specify:
Maid Requirements
Nationality of Domestic Helper:
Maid Required for:
If Other, please specify:
Household Duties Details
Pets:
If Pets present, please state Qty and Breeds:
(eg: Dog: 2, Breeds: German Shepherd, Golden Retriever)
Elderly or Children with special health conditions:
Car Wash Required?
Mobility of Domestic Helper: Will the Domestic Helper need to travel between 2 Houses?
Requirements of Domestic Helper (if required):
Age:
Educated:
Married:
Have children:
Experienced:
Work Requirements

Please Rate your Expectations of the following.

Cleaning:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Gardening:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Handwashing:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Laundry:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Cooking:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Childcare:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Elder care:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Pet Care:

	1	2	3	4	5	6	7	8	9	10

1 is Lowest, 10 is Highest

Employer Details