If you feel you are a qualified applicant please fill
out the following information.
Name:
Street Address:
City, State, ZIP:
Phone Number:
Email:
Position Applying for: (select as many as necessary)
Nanny
 Nanny/Housekeeper
 Couple
Housekeeper
 Personal Assistant
 Cook/Chef
Companion
 Houseman
 Other
Live In
 Live Out
Are you looking
for:
Part Time
 Full Time
Do have a valid
U.S. Driver's
license?
Yes
 No
When can you
start?
How did you hear
about us?
Employment History:
Family Name:
Street Address:
City, State, ZIP:
Phone Number:
Job Title:
Duties:
Start Date:
Start End:
Reason for
Leaving:
Family Name:
Street Address:
City, State, ZIP:
Phone Number:
Job Title:
Duties:
Start Date:
Start End:
Reason for
Leaving:
Family Name:
Street Address:
City, State, ZIP:
Phone Number:
Job Title:
Duties:
Start Date:
Start End:
Reason for
Leaving:
Additional Comments:
Domestic Solutions Agency
A professional domestic placement agency
Domestic Solutions Agency
  • 7805 Sunset Blvd. Suite #209
  • Los Angeles, Ca.
  • 90046
  • 323-845-1433
  • 310-276-2403
  • 323-845-1437 Fax