Free employment contract 04Free employment contract 04Free employment contract 04
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Revised October 23, 2017

A-3 AND G-5 EMPLOYMENT CONTRACT TEMPLATE
EMPLOYERS of A-3 and G-5 domestic workers in the United States may wish to use the employment
contract template developed by the Department of State as it includes all Department-required contract
terms.
Instructions: Complete the text and check the appropriate boxes.
PARTIES:
EMPLOYER
SURNAME Click here to enter surname. GIVEN NAME Click here to enter given name.
RANK TITLE Click here to enter EMPLOYER rank/title.
DUTY OFFICE Click here to enter EMPLOYER duty office.
RESIDENCE ADDRESS Click here to enter residence.
EMPLOYEE
SURNAME Click here to enter surname. GIVEN NAME Click here to enter given name.
DATE OF BIRTH Click here to enter a date of birth. NATIONALITY Click here to nationality.
IS THE EMPLOYEE RELATED TO EMPLOYER?
IF YES, LIST RELATIONSHIP.

☐YES ☐ NO

Click here to enter relationship.

HAS THE EMPLOYEE WORKED FOR THE EMPLOYER PREVIOUSLY?

☐YES ☐ NO

HAS THE EMPLOYEE PREVIOUSLY WORKED AS A DOMESTIC WORKER?