Gentle Hands Companions and Housekeepers
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About Gentle Hands
Housekeepers & Companions
Baby Nurses
Doulas
Nannies
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Application Forms
Questions
The Area Served
Application Form for Housekeepers & Companions
This form is for service inquiries only.

Gentle Hands is a referral and employment agency that agrees to provide services for clients seeking Baby Nursing, Postpartum Care and Labor Support Doulas and Nannies.

All of our staffs are certified in CPR and First Aid with certifications in their respective fields of employment.

Use this form to send your application to us via e-mail.
Full Name:
Address:
Apartment Number:
City:
State:
Zip Code:
Home Phone:
Fax Number:
E-mail:
Information of person that will receive care:
First Name:
Last Name:
Address:
Apartment Number:
City:
State:
Zip Code:
Phone Number:
Age:
Male Female
Please check type of care needed:
live-in
weekends
live-out
driver
non-driver
Hours per Week:
*Required Minimum of 20 hours
Desired Starting Date: Immediately or on
Are there any pets in the home? If yes, please explain.
Accommodations and benefits provided for the companion.
Private Room
Phone
Paid Vacation and Holidays
Major Holidays Off
TV
Access to Car
Please describe
Work Schedule
Mo. - Fr.
Start:
Finish:
Tu. - Sa.
Start:
Finish:
Weekends
Start:
Finish:
Weekly Salary:
Hourly Rate:
Please describe in detail the health information regarding the client and additional information we should know.

   
Gentle Hands
Phone: 718-859-8572
www.GentleHandsCompanions.Com
E-mail: companions@gentlehandscompanions.com