Applicant Agreement and Background Check Form

Please note: Your first step to apply for domestic jobs with us, is to do a brief, 10-minute online Video Interview. If you have already done your Video Interview, then please complete the Applicant Agreement and Background Check Form below now.  

(If you have not already done your Video Interview, please do it now and then return to this page to complete your Applicant Agreement and Background Check Form.)



WHEREAS, the Applicant is a Housekeeper, Houseman, Chef, Chauffeur, Estate Manager, part of a Domestic Couple, Personal Assistant, Companion, Nanny, Office Worker, Retail Worker, Server, Bartender, or other domestic, office, or retail staff member who has expertise in providing domestic, office, or retail staff services (the “Services”).

WHEREAS, the Applicant desires to enter into an agreement pursuant to which the Agent will refer the Applicant to various employers and possibly place the Applicant with an employer with which the Agent has a contractual relationship (hereinafter referred to as “Employer”) for the provision of the aforementioned services upon the term and conditions hereinafter set forth.

Now therefore, in consideration for the mutual covenants contained herein, the Agent and Applicant agree as follows:

CONTRACT TERM. This Agreement shall commence on the date indicated above and shall remain in full force and effect until terminated as herein provided.

APPLICANT EMPLOYMENT. If Applicant is placed with and works for an Employer, then Applicant is an employee solely of Employer. Applicant will at no time and to no extent be an Employee of Hamptons Employment Agency. The Applicant is not and shall not become, by virtue of the relationship described herein, an employee of the Agent. Both parties to this agreement acknowledge and agree that the Applicant’s relationship to the Agent shall be restricted to the act of referral and placement of Applicant for full-time live-in, full-time live-out, temporary, seasonal live-in, seasonal live-out, or part-time domestic positions at Employer households or full-time or part-time positions at Employer offices or stores. Moreover, the Agent shall not direct, supervise or control directly or indirectly the Services that the Applicant provides. The Applicant acknowledges and agrees that all Services performed by the Applicant at any household, office, or store are performed as a referral/placement, and that the Employer is responsible for providing Applicant’s unemployment insurance and/or disability insurance. Hamptons Employment Agency, Inc. assumes no responsibility for paying or withholding any federal or local taxes, social security contributions, or insurance premiums required or arising from the Applicant’s employment with the Employer. As a referral agency, HEA is in no way and to no extent responsible for paying monies (or any other compensation) owed by an Employer for work performed by a placed Applicant for the Employer.

APPLICANT INDEPENDENCE AND DISCRETION. The Agent does not have the authority to supervise, direct, or control the manner, means, details, or methods utilized by the Applicant to provide the Services to any Employer’s household or business to which the Applicant is responsible. Moreover, Applicant shall act in a manner consistent with generally accepted domestic or business staff procedures and acts of conformity. The Applicant agrees that if Hamptons Employment Agency, Inc. finds that the Applicant is being subjected to exploitive conditions in the Employer’s household or business (as determined by Hamptons Employment Agency, Inc. in its sole judgment), then Hamptons Employment Agency, Inc. may withdraw the employee from the household or business at the Applicant’s request. Applicant assumes sole and complete responsibility for screening and assessing any potential Employer. Applicant acknowledges that his or her decision to work for any Employer is based solely on his or her own proper assessment of the given Employer, and HEA is not responsible for making the final assessment of an Employer for Applicant. In addition, Applicant acknowledges the health risks posed by COVID-19 (the Coronavirus), as explained by the CDC (see and many other U.S. government agencies. Applicant also acknowledges that the Agency has taken reasonable precautions to help prevent the spread of COVID-19, including posting a publically available COVID-19 notice to employers and applicants on the Agency’s website. Applicant further acknowledges that the Agency, its employees, and its representatives cannot be held liable for any exposure to COVID-19 that is in any way connected with the employment, engagement, or attempted employment of Applicant by any Employer introduced to Applicant by the Agency, regardless of how, when, or where such liabilities are incurred.

DRUG AND ALCOHOL POLICY. During the application process – that is until an Applicant is placed (if such placement occurs) – Agency may perform periodic, unscheduled drug and alcohol testing at any time. Illicit drug use is not permitted: Agency has a “zero-tolerance” drug policy. Alcohol may not be consumed during meetings or other functions related to the application process.

CPR CERTIFICATION FOR INFANT/CHILD CARE. It is understood that for Applicant placement in a child care role, CPR Certification is a requirement and proof of such certification must be provided for Applicant’s placement file prior to any placement.  In the event that Applicant is not CPR-Certified for infant and child care, Applicant must obtain this by contacting his or her local Fire Department, American Red Cross, or any other organization or hospital providing a CPR class (this must be done prior to placement). Additionally, it is understood that Applicant is responsible for paying the fee in full.

AIRFARE AND TRAVEL EXPENSES. The Applicant understands that he or she is expected to pay his or her airfare or any other travel expenses if he or she must relocate from his or her home to accept a job with an Employer. Arrangements must be made with Employer for Applicant to obtain any form of travel expense reimbursement (The Agency will provide no travel expense reimbursement whatsoever).

CONFIDENTIALITY. Applicant agrees to hold in complete confidence all information provided by the Agency about prospective Employers. In the event that Applicant is hired by an Employer, Applicant will at all times maintain complete confidentiality regarding the affairs and concerns of Employer’s household and its members, and Applicant will respect the family’s right to full privacy. Applicant also agrees to keep all contents of this Agreement confidential.

NON-DISPARAGEMENT. As consideration for HEA’s assistance, to whatever extent, to Applicant in his or her job search, Applicant agrees to take no action which is intended, or would reasonably be expected, to 1) materially harm HEA, any affiliate of HEA, or HEA’s respective businesses, officers, directors, or employees; 2) harm the reputation of any of the foregoing persons or entities; or 3) which would reasonably be expected to lead to unwanted or unfavorable publicity for any of the foregoing persons or entities. Applicant agrees not to disparage HEA in any way, including but not limited to verbal statements, Internet reviews, and written communications and documents.

ARBITRATION & ENTIRE AGREEMENT. This agreement shall be governed by the laws of the State of New York, without reference to any conflicts of law principles. This agreement represents the entire agreement between the parties with respect to the subject matter hereof. It supersedes any and all prior agreements and understandings, oral or written, between Employee and the Company with respect to such subject matter. No amendment or termination of this Agreement shall be effective or binding unless in writing and signed by the party against whom enforcement thereof is sought. This Agreement shall apply to, bind, and inure to the benefit of the parties hereto, and where applicable, their heirs, successors, administrators, and assigns.

ACCEPTANCE OF POSITION. Upon acceptance of a domestic staffing position, Applicant must maintain his or her availability until the placement’s commencement date.

NO-SHOWS. In the event that Applicant does not show up for a scheduled interview or for the first day of placement with an Employer, Hamptons Employment Agency, Inc., will withdraw Applicant’s registration with the Agency, and the Agency will no longer place Applicant with any Employer.

WORK AGREEMENT. Applicant agrees to sign a written work agreement with Employer that outlines the terms of employment with Employer. Moreover, Applicant will provide Hamptons Employment Agency, Inc., with a copy of the work agreement. For a permanent placement of Applicant, Applicant must commit to a minimum placement of one year of service with the Employer. In the event that the Applicant is not happy with his or her placement, then Applicant must immediately notify the Agency. Moreover, Applicant agrees not to end employment with the Employer until alternate arrangements have been made to ensure that Employer has a domestic or business staff member to meet Employer’s needs.

NON-SOLICITATION & NON-COMPETE. As consideration for HEA’s assistance, to whatever extent, to Applicant in his or her job search, Applicant agrees to the following:  for a period of three (3) years following any discontinuance of work with HEA, the Applicant shall not 1) directly or indirectly hire, solicit, or encourage to leave HEA’s employment, any employee, consultant, or contractor of HEA; or 2) hire any such employee, consultant, or contractor who has left HEA’s employment or contractual engagement within three (3) years of such employment or engagement. Moreover, Applicant covenants and agrees that, during the term of this agreement with HEA and for five (5) years after any termination thereof, regardless of the reason for the termination, Applicant will not, directly or indirectly, solicit and/or provide any domestic, event, retail, or office services – including, but not limited to, chef/cooking, serving, houseman, handyman, pool, cleaning, bartending, and spa/salon services – to any HEA client.

REFERRAL. Applicant understands that all potential Employers referred to or discussed with Applicant will not refer the Applicant to outside job placement resources at any time during, before, or up to two years after placement. Such job placement resources include, but are not limited to, other agencies, Employer family members, Employer friends and other third parties, etc.

OBLIGATIONS OF HAMPTONS EMPLOYMENT AGENCY INC. Applicant understands that nothing in this contract is intended to guarantee that Hamptons Employment Agency, Inc. will find a suitable position for Applicant. If a position is accepted by Applicant as a result of a placement by the Agency, and Applicant or Employer ends the employment, then Applicant understands that the Agency is not required to assist in finding Applicant another job or to reimburse Applicant for any expenses incurred as a result of the job placement.


All information supplied by Applicant during the application process must be true and complete to the best of Applicant’s knowledge.  Any misrepresentation or omission of facts by Applicant may be sufficient cause, in and of itself, for rejection or dismissal whenever discovered.

Applicant expressly authorizes, without reservation, the Agency and the Employer, and their representatives, employees, or agents, to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions, and to otherwise verify the accuracy of all information provided by Applicant in this application, resume, or job interview. Applicant hereby waives any and all rights and claims that he or she may have regarding the Agency or the Employer, and their agents, employees, or representatives, for seeking, gathering, and using such information in the employment process.

Applicant expressly authorizes, without reservation, the Agency to share any HEA Online Video Interview materials submitted by Applicant with Agency employees, clients, and potential clients, for the purpose of evaluating Applicant’s candidacy for domestic positions.

Applicant hereby authorizes Hamptons Employment Agency to investigate Applicant’s background and qualifications for purposes of evaluating whether Applicant is qualified for the position for which Applicant is applying. Applicant understands that Agency will utilize an outside firm or firms to assist it in checking such information, and Applicant specifically authorize such an investigation by information services and outside entities of the company’s choice. Applicant hereby waives any and all rights and claims that he or she may have regarding the Agency or the Employer, and their agents, employees, or representatives, for seeking, gathering, and using such background check information in the employment process. Applicant also understands that he or she may withhold permission and that in such a case, no investigation will be done, and Applicant’s application for employment will not be processed further. 

Applicant understands that Hamptons Employment Agency does not unlawfully discriminate during the interviewing or placement process. Moreover, Applicant understands that no content in this agreement, or questions asked in interviews and applications and other forms required of Applicant by the Agency, is used for the purpose of limiting or excusing any applicant for consideration for employment on any basis prohibited by applicable local, state, or federal law.

Applicant agrees that if Hamptons Employment Agency, Inc. does place Applicant in a position, then Applicant will notify Hamptons Employment Agency, Inc. within 24 hours that the Employer desiring Applicant’s employment has hired Applicant or has agreed to a trial placement period. In addition, if an Agency-referred Employer contacts Applicant directly, then Applicant shall inform Hamptons Employment Agency, Inc., of such occurrence immediately. Applicant will not work for any family that he or she have been referred to by Hamptons Employment Agency, Inc., without having permission to do so, for a period of at least three years after the initial introduction. Furthermore, it is agreed and understood that it is Applicant’s responsibility to: 1) contact and maintain communication with Hamptons Employment Agency during any trial period and 2) contact Hamptons Employment Agency immediately following an offer of permanent hire.

Applicant has been fully informed by the Agency and any potential Employer of the reasons for any Criminal, Psychological, Drug, or Alcohol screening tests required or that may be required in the future as part of the placement process. Applicant understands what he or she is being tested for, and Applicant hereby freely gives his or her consent to the aforementioned tests. In addition, Applicant understands that the results of the tests will be forwarded to his or her potential Employer and become part of the Applicant’s record with the Agency. Applicant hereby authorizes these tests results to be released to Hamptons Employment Agency, Inc. Applicant also understands that if he or she is hired by an Employer, then Applicant will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require Applicant to complete an I-9 Form.

IN WITNESS WHEREOF, Applicant has executed this Agreement effective as of the day and year entered below by Applicant.


The information contained in the HEA Job Application I submitted, as well as other information I’ve provided to HEA, is correct to the best of my knowledge.

I hereby authorize Hamptons Employment Agency, Inc. and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to Hamptons Employment Agency, Inc. or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. Hamptons Employment Agency, Inc. and its designated agents and representatives are permitted to share background check reports with potential employers, but shall otherwise maintain all background check information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and birthday.

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