CLIENT FORM SERVICE USER JOB DESCRIPTION FORM CLIENT NAME ADDRESS MOBILE NO. EMAIL ID PAN CARD NO. AADHAR CARD NO. DATE OF BIRTH MARRIAGE ANNIVERSARY DATE QUALIFICATION OCCUPATION MONTHLY INCOME Below 50 K 51 K to 70 K 71 K to 1 LK 1 LK to 2 LK 2 LK & Above Family Background Name Relation Occupation Education Birth Date PREMISES AREA 1BHK - Sqft 2BHK- Sqft 3BHK - Sqft 4BHK- Sqft Other- Sqft JOB PROFILE (Pls. tick mark, for whichever is required) Housemaid Baby Sitter/Nanny JAPA Maid Elder Care Cooking Caretaker DUTY HOURS (Pls. tick mark, for whichever is required) 4 hrs 8 hrs 10 hrs 12 hrs 24 hrs AMC JOB DESCRIPTION HOUSEMAID Utensils Cleaning Floor Cleaning Dusting Bathroom Cleaning Washing Clothes Ironing Clothes Grocery Shoping Gardening Other BABAYSITTER Baby Bath Cleaning Utensils Cooking for Baby Diaper Change Feeding Washing baby cloth Baby Massage Drop in School/ Van Walk/Play with Baby ELDER CARE Bath / Sponging Cleaning Utensils Cooking for Patient Diaper Change Feeding Medication Injection Massage Walk with elderly COOKING Vegetarian Non Vegetarian Breakfast Lunch Dinner WORK FREQUENCY Fridge Cleaning Daily After 2 Days After 3 Days Weekly Monthly Cubboard Daily After 2 Days After 3 Days Weekly Monthly Change Bedsheet Daily After 2 Days After 3 Days Weekly Monthly Window Glass Daily After 2 Days After 3 Days Weekly Monthly Other Daily After 2 Days After 3 Days Weekly Monthly FACILITY FOR SERVANT (Pls. tick mark, for whichever is required) Tea Meal Accomodation Medicine Personal Care Material Other DEADLINE (Pls. tick mark, for whichever is required) Immediate ------- days 1 week 2 week 1 Months Not Urgent REST PERIOD FOR EMPLOYEE NIGHT SLEEP hrs. GROOMING Hour BREAKFAST Min. LUNCH Hour DINNER Hour PERSONAL TIME Hour FACILITY FOR EMPLOYEE (Pls. tick mark, for whichever is applicable) Tea/ Breakfast Lunch Dinner Bedding Clothes Utensils Medicine Accomodation Toilet Bathroom Personal Care Material Other SALARY OF EMPLOYEE PER MONTH BONUS OF EMPLOYEE PER YEAR SERVICE CHARGES OF SERVICE PROVIDER PER YEAR WORK CHARGES OF EMPLOYEE FOR EXTRA PERSONS VISITING SERVICE USERS HOUSE / OFFICE PER DAY Rs. Per Relative Per Day Rs. Per Guest Per Day Rs. Per Client Per Day PAID LEAVES OF EMPLOYEE PER MONTH 2 Days per Month REQUIREMENT (Pls. tick mark, for whichever is required) Immediate ------- days 1 week 2 week 1 Month Not Urgent PLACE DATE CLIENT SIGNATURE I accept the T&C and understand that this info will be used by Maideasy to offer me service. SUBMIT
