Model Domestic Worker Employment Agreement

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The Employer and Domestic Worker should negotiate the terms of the agreement to best suit

both parties, subject to the requirements of state and federal law. Completing all parts of this

document, supplying a copy this agreement to the Domestic Worker prior to the

commencement of work (and at the time that any changes to the agreement are made), and

retaining a copy for three years following the end of employment fulfills the employer’s

obligation to provide a record of information in accordance with M.G.L. c. 149, § 190(l) and 940

C.M.R. 32.04(3).

This agreement is entered into between (“Employer”)

and (“Domestic Worker”) on (date).

1. Beginning date of employment:

2. Employment length:

 Until either party terminates the agreement.

 For a fixed term:

(#)  Month(s)  Year(s)  Other:

3. Position Title:

4. Supervisor Name: __________

Contact Information:

5. Location of Employment (address):

6. Employer’s Address: __________________________________________________________

___________________________________________________________________________

7. Work Responsibilities (check all that apply and, if applicable, describe nature):

 Housekeeping _____________________________________________________________

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 House cleaning_____________________________________________________________

 Home management _________________________________________________________

 Childcare and nanny services

Description of child(ren) (number of children, name, age, gender, etc.):

______________________________________________________________________

Description of duties related to care of child(ren):

______________________________________________________________________

 Adult care, including sick, convalescing, and elderly individuals

Description of adult(s) (number of adult(s), name, age, gender, etc.):

______________________________________________________________________

Description of duties related to care of adult(s):

______________________________________________________________________

 Laundering: _______________________________________________________________

 Cooking: __________________________________________________________________

 Home companion services: ___________________________________________________

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 Pet care: __________________________________________________________________

 Other:

8. Work Schedule: Domestic Worker will work the following days and hours:

 Sunday Start Time: am/pm End Time: am/pm

 Monday Start Time: am/pm End Time: am/pm

 Tuesday Start Time: am/pm End Time: am/pm

 Wednesday Start Time: am/pm End Time: am/pm

 Thursday Start Time: am/pm End Time: am/pm

 Friday Start Time: am/pm End Time: am/pm

 Saturday Start Time: am/pm End Time: am/pm

9. Rest and Breaks: Domestic Worker will receive the following:

 Days off (specify) __________________________________________________________

Domestic workers who work at least 40 hours a week are entitled to 24 consecutive hours of rest each week

and 48 consecutive hours of rest each month.

 Workday meal and rest breaks

min. ______ times a day  paid  unpaid

 Sleeping period (specify)  paid  unpaid

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 Other: ___________________________________________________________________

10. Compensation

a. Regular rate of pay is $ per hour.

Overtime rate of pay is $ per hour for every hour (or fraction

thereof) worked over 40 per week.

The regular day(s) of pay will be every ________________________________________

The Massachusetts minimum wage is $9.00 per hour. Most employees are entitled to 1.5 times their

regular hourly pay for each hour worked after 40 hours in a week.

 Domestic Worker will be entitled to a % raise every year.

b. Domestic Worker will receive additional compensation of _____________ for the

following (e.g., added duties, additional multilingual skills, travel, additions to

Employer’s household):

c. Domestic Worker will receive the following additional benefit(s) (e.g., transportation or

reimbursement for transportation, health insurance or reimbursement for health

insurance premiums, etc.):

_______________________________________ _________________________________

________________________________________________________________________

11. Wage Deductions:

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Employer will make the following deductions from Domestic Worker’s wages:

 State income tax withholding

 Federal income tax withholding

 Social Security/Medicare

 Health Insurance: $ per (paycheck, month, etc.)

 Food and beverages: $ per (paycheck, month, etc.)

Max. $1.50 for breakfast, $2.25 for lunch, and $2.25 for dinner. Must reflect actual cost of food and

beverages actually provided Domestic Worker. Not permitted if required by Employer or if

household dietary restrictions prevent Domestic Worker from consuming preferred food or

beverages.

 Lodging: $ per (paycheck, month, etc.)

Max. $35.00 per week for a room used by one person, $30.00 per week for a room occupied by two

people, and $25.00 per week for a room occupied by three or more people. Not permitted if lodging

in any particular location is required by Employer or not actually used by Domestic Worker.

 Other (specify the purpose, frequency, and amount of the deductions):

____________________________________________________________________

12. Leave Policies

Domestic Worker will receive the following leave:

 Sick leave (specify quantity, accrual method, allowable purposes, notice requirements,

carryover, whether it is paid or unpaid, and any other conditions):

Effective July 1, 2015, domestic workers have the right to earn and use up to 40 hours of sick time in a

calendar year. If an employer has more than 11 employees, earned sick time must be paid. The time

may be unpaid if an employer has fewer than 11 employees. M.G.L. c. 149, § 148C.

________________________________________________________________________

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 Vacation leave (specify quantity, accrual method, notice requirements, carryover,

timing, whether it is paid or unpaid, and any other conditions):

________________________________________________________________________

 Parental leave for birth or adoption of a child (specify duration, notice requirements,

whether there is a probationary period, whether it is paid or unpaid):

Domestic workers who are employees are entitled to take up to eight weeks of unpaid, job-protected leave

for the birth or adoption of a child, in accordance with the Parental Leave Act, M.G.L. c. 149, § 105D.

Employees must give at least two weeks’ notice of anticipated date of departure and intention to return.

_______________________________________ _________________________________

________________________________________________________________________

 Other: _____________________________________________________________

________________________________________________________________________

Domestic Worker will receive the following paid holidays off (check all that apply):

 New Year’s Day  Martin Luther King, Jr. Day

 President’s Day  Memorial Day

 Independence Day (July 4)  Labor Day

 Columbus Day  Veteran’s Day

 Thanksgiving Day  Christmas Day

 Other:  Other:

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 Domestic worker will receive holiday premium pay of $_____________ for working on

the following holidays:

13. Living Accommodations

 Domestic Worker will live in the following accommodations provided by Employer:

 Employer’s home (address and description of living quarters):

______________________________________________________________________

 Other location (address and description of living quarters):

______________________________________________________________________

 Employer requires that Domestic Worker reside at this location.

 Employer will not enter Domestic Worker’s designated living quarters except under these

conditions: _________________________________________________________________

__________________________________________________________________________

___________________________________________________________________________

*Both the Domestic Workers Bill of Rights and the Attorney General’s regulations contain specific provisions

regarding a domestic worker’s right to privacy. Nothing in this agreement shall contravene those

requirements of the law.

 Domestic Worker will have the following opportunity to access telephone and Internet

services on premises: _______________________________________________________

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18. Termination or Severance of Employment

Employer will inform Domestic Worker at least weeks in advance of termination or

Domestic Worker will receive weeks of pay in lieu of notice, unless termination is

for cause.

Domestic Worker will inform Employer at least weeks in advance when terminating

this employment.

The following shall constitute cause for termination (not an exhaustive list):

If Domestic Worker resides in Employer’s household and Employer terminates employment, Employer must

provide written notice and either 30 days of lodging, either on-site or off-site, or severance pay equivalent to

Domestic Worker’s average earnings during the last two weeks of employment, pursuant to M.G.L. c. 149, §

190(k).

No advance notice or severance payment shall be required where the employer provides a good faith allegation

that the domestic worker has abused, neglected, or caused any other harmful conduct against the employer,

members of the employer’s family, or individuals residing in the employer’s household, as described in 940 C.M.R.

32.03(19).

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19. Evaluations

After three months of employment, domestic workers have the right to request a written evaluation. While not

required by law, written evaluations may aid in ensuring that all job duties are performed at a satisfactory level.

 A written evaluation of work performance will be performed on the following basis:

20. Raising and Addressing Grievances

Employer and Domestic Worker will use the following process to raise and address grievances:

______

21. Workers’ Compensation

If Domestic Worker is injured on the job, Domestic Worker may be eligible to collect workers’

compensation benefits.

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22. Signatures to the Agreement

The undersigned parties have reviewed and voluntarily agree to abide by the terms set out in

this agreement.

Employer’s Signature Date

Employer’s Name

Domestic Worker’s Signature Date

Domestic Worker’s Name

Signature of additional household employers (if Domestic Worker is hired to perform shared

services)

Shared Services Employer’s Signature Date

Shared Services Employer’s Name

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Acknowledgement of Receipt of Written Employment Agreement

I, __________________ , acknowledge that I have received a copy of the

employment agreement with _______________ dated ____________ .

Domestic Worker’s Signature Date

Domestic Worker’s Name

Fillable Printable Model Domestic Worker Employment Agreement

Fillable Printable Model Domestic Worker Employment Agreement