name
address
home phone
work phone
fax
mobile no
e-mail
hours per week
what time
am
pm
days of the week
mon.
tus.
wed.
thu.
fri.
sat.
sun.
any day
how often
weekly
fortnightly
one-off
size of house
bedrooms
1
2
3
4
bathrooms
1
2
3
4
reception
1
2
3
4
levels
1
2
3
4
Ironing requested?
yes
no
Are there any pets?
yes
no
Further comments: