Martha’s Way Housekeeper Request Form

Thank you for your interest in hiring a Martha’s Way graduate to be your housekeeper. Please complete this form, providing as much detail as you can.  This will help us to match you with housekeepers that will best meet your needs. Please click here if you prefer to print out this form and complete it.

    Contact Information

    How did you hear about Martha’s Way?

    FriendWebsiteChurchOther

    (please specify):

    (please specify):

    Position Information

    Frequency:

    MonthlyEvery Two WeeksWeeklyOther

    (please specify):

    Home Specifics:

    Cleaning Supplies:

    I wish to provide supplies/chemicalsHousekeeper should bring own supplies

    English Proficiency:

    Many of our students speak minimal or conversational English, but understand the most of the language. Would you accept a job applicant with minimal English?

    English not needed. (I or someone in my household is fluent in Spanish.)Minimal English speaking is okay.I need someone who is fluent in English.

    Housekeeping Checklist

    Part I:

    The items listed below are standard expectations for cleaning service. Please check tasks you would like completed.

    • Living Areas

      • Dust and vacuum

      • Dust pictures, ceiling fans and blinds

      • Clean mirrors, TV screens

      • Furniture care?

          Select type of upholstery:

        • Leather/Fabric.Other?

          (please specify):

      • Dust and mop floors?

          Select type of flooring:

        • vinyltilehardwoodcarpetantique/oriental rugs

      • Special chemicals/care?

      • Other special requests?

    • Kitchen

      • Sweep floors?

          Select type of flooring:

        • vinyltilehardwoodother

      • Mop?

        • Specific products?

      • Clean all applicances/stove top/sink?

      • Clean counter tops?

          Select type of counter surface:

        • Coriangraniteformicatileother

      • Clean all applicances/stove top/sink?

      • Special chemicals?

      • Other special requests?

    • Bathrooms

      • Clean santize and deordorize?Clean and disinfect shower(s)/tub(s)/sink(s) and tile surfaces?Sweep/mop/vacuum?

      • Special chemicals?

      • Other special requests?

    • Bedrooms

      • Make beds?Change linens? (If you would like linens changed, please leave them out on bed)Vacuum/Dust/Straighten

      • Special chemicals?

      • Other special requests?

    Part II:

    Special Projects may be needed periodically. Most special projects take additional time beyond standard cleaning. Additional hourly fees may apply.

    • Laundry and/or ironing

        Please state any special instructions

    • Extra care for fine furnishings/home accessories

        Please note any special chemicals you would like used or special handling on fine furnishings

    • Pet care/other special requests

    Additional Information

    Please add any additional information you would like us to know about the position.

    Statement of Understanding

    Christian Community Service Center (CCSC) is a not-for-profit organization. CCSC provides a resource center for job seekers. It is not an Employment Placement Agency, nor does it engage in the business of placing clients directly with employers. Businesses or individuals seeking employees can list their job openings with CCSC free of charge. This is no guarantee that a qualified candidate will be available for the position(s) listed, and it is the responsibility of the client to contact the employer for additional information. CCSC does not receive any direct remuneration from businesses or individuals that find employees through its services. It is the sole responsibility of the prospective employer to check references, immigration status and any other applicable background information. No guarantee is either expressed or implied as to the correctness of information provided by the clients in the application form.

    Digital Signature

    Note: Please type First and Last name in the box

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