Family Assistant Questionnaire - J Danielle

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(858) 225-8198 | staffing@jdanielle.com

| 6012 Paseo Delicias #3, Rancho Santa Fe CA 92067

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Family Assistant Questionnaire

1Personal Info

2General Preferences

3Duties Include

4Additional Requests/Notes

Family name*
Email*
Phone*
How did you hear about us?

Estimated start date
Location Address
Age of children if applicable
Full time, Part time, Temp?
- Full time
- Part time
- Temp
Desired Days/Hours
Pay rate approx. range*

(Please indicate hourly or salary)
Health benefits/401K applicable?
- Yes
- No
Female or male ("manny") preference
- Male
- Female
Live-in or Live-out?
- Live-in
- Live-out
- Either
If Live-in, separate living quarters?*
- Yes
- No
Relocation costs covered?
- Yes
- No
Household is Casual, Semi-formal or Formal?
- Casual
- Semi-formal
- Formal

General childcare
- Yes
- No
Home office work
- Yes
- No
Cooking
- Yes
- No
Laundry / ironing
- Yes
- No
Shopping
- Yes
- No
Driving / errands?
- Yes
- No
Help with family/kids/pets?
- Yes
- No
Table service/parties
- Yes
- No
Cook in or serve food already prepared
- Cook in
- Serve Food
Please add….

Special diet requirements
Allergies to be aware of
It would be really nice if….
Misc.
Advanced Background Check from 3rd party + $60
- Yes
- No

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Jamie Danielle Staffing

6012 Paseo Delicias #3
Rancho Santa Fe CA 92067
Email: staffing@jdanielle.com
Phone: 858.225.8198
Fax: 858.724.1442

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