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):

English Mandarin Cantonese Bahasa Melayu
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:

Apartment Condo Semi-Detached House Single-Storey Terrace House Double-Storey Terrace House Bungalow Other
If Other, please specify:
Maid Requirements
Nationality of Domestic Helper:

Filipino Indonesian
Maid Required for:

General Housekeeping Nanny Elder care Special Needs Child Disabled Elderly Disabled Child Newborn Pets Other
If Other, please specify:
Household Duties Details
Pets:

Cat Dog
If Pets present, please state Qty and Breeds:
(eg: Dog: 2, Breeds: German Shepherd, Golden Retriever)
Elderly or Children with special health conditions:

Yes No
Car Wash Required?

Yes No
Mobility of Domestic Helper: Will the Domestic Helper need to travel between 2 Houses?

Yes No
Requirements of Domestic Helper (if required):
Age:
Educated:

Yes No
Married:

Yes No
Have children:

Yes No
Experienced:

Yes No
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

Priority (eg: childcare & cleaning) :
Domestic Helper Benefits
Usage of Mobile Phone Allowed?

Yes No
Day Off (Sunday):

Yes No ( RM65/RM42 per day off will be chargeable ) No (Rest at Home)
Best Time & Day

for us to Call you:
(All calls will be returned within 48 Hrs)
Annual Declared Income Range:
Should be Empty:

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Employer Details

Family Members Details

Maid Requirements

Household Duties Details

Requirements of Domestic Helper (if required):

Work Requirements

Domestic Helper Benefits

Best Time & Day