U.S.

DEPARTMENT OF LABOR
Employment Sample Agreement for Home Care Workers
Domestic workers across the United States are doing critical work to ensure that our economy functions
and our families and communities thrive. Yet while care for households, children, people with
disabilities, and older adults is invaluable, domestic workers—who are disproportionately women,
immigrant women and, depending on the job, disproportionately women of color—too often work in
precarious conditions without formalized employment arrangements. Families employing domestic
workers may have little experience as employers and may not understand their legal responsibilities,
their employees’ rights, and best practices for maintaining a high-quality, healthy and safe employment
environment.
In April 2023, President Biden issued the Executive Order on Increasing Access to High-Quality Care and
Supporting Caregivers, which directed federal agencies to undertake the most comprehensive set of
executive actions ever issued to improve care for families while supporting care workers and family
caregivers. The Executive Order called on the Secretary of Labor to develop compliance assistance and
best practices for domestic care workers and their employers to promote fair workplaces and ensure the
parties know their rights and responsibilities.
To support this effort, the U.S. Department of Labor developed sample employment agreements, for
illustrative purposes, for household employers and cleaners, home care workers, and nannies . These
sample agreements are a tool that both household employers and domestic workers can choose to use
as a helpful starting point to facilitate an open discussion about and create a shared understanding of
the terms of employment. These sample agreements may help household employers and workers
develop their own employment agreements together, thereby reducing potential future
misunderstanding or conflict and strengthening the employment relationship and trust.
The use of these sample agreements is not required by law. The provisions in the sample agreements
do not necessarily represent legal obligations, but instead reflect topics that employers and
employees may voluntarily choose to address. The sample agreements do not constitute legal advice
by the U.S. Department of Labor and do not reflect the full range of laws that may apply in every
situation, including local and state laws that may provide additional protections and requirements.
Employers should review local, state, and federal laws to ensure they are in compliance with the law that
provides the most protections for employees and should include additional legal requirements as
necessary in their own agreements. Parties remain independently responsible for complying with
applicable law.
Numerous laws establish rights and protections that cannot be waived or abridged by private contracts.
Use of an employment agreement should not be construed to waive the rights or protections of an
employee under applicable federal, state, or local law. The agreement may provide rights or protections
to the relevant party that are separate from federal, state, or local law. This publication is for general
information to provide a voluntary resource for employers and employees and is not considered in the
same light as official statements of position. The contents of this sample agreement do not have the
force and effect of law and are not meant to bind the public in any way.
 Sample Written Agreement for Home Care Workers
I. Basic Information
This written agreement lays out the agreed-upon terms of employment and home care services
between ______________________________ (“Employer”) and
______________________________ (“Employee”).
1. Employer name: __________________________________
a. Employer contact information: _______________________________________
b. Emergency contact: ________________________________________________
2. Employee name: _________________________________________________________
a. Employee contact information: ________________________________________
b. Emergency contact: ________________________________________________
3. Individual(s) receiving care services:
Full Name Age Emergency Contact Additional information about
individual receiving care services

4. The place of work is located at (address):

________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
5. The start date of employment is ____________________________________________.
6. The length of employment (check one):
 Option 1: The length of employment is until either party ends the agreement.
 Option 2: The employment relationship between the parties will end on
______________________________ (“Termination Date”).

II. Job Responsibilities

1. The Employee agrees to perform the following duties (check all that apply):

Personal and Health Care

 Assist with transfers (limiting the total number of transfers required per shift
such that the long-term health and safety of the Employee is balanced with the
care needs of the Employer to the maximum extent feasible)
 Stand
 Cradle
 Equipment-assisted transfer
 Assist up/down stairs

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
  Assist with walking
 Assist with bathing
 Assist with dressing/undressing
 Assist with grooming
 Assist with toileting
 Provide bowel and bladder care
 Provide diapering
 Assist with exercising
 Assist with or administer medication
 Other tasks, including: ______________________________________________

Household Support
 Prepare meals
 Assist with feeding
 Clean dishes and kitchen
 Shop for groceries
 Wash, dry, fold, and put away laundry
 Change bed sheets
 Run errands
 Coordinate transportation
 Provide transportation to/from: ______________________________
 Light cleaning, including: ________________________________________
 Pet care, including: ________________________________________
 Other tasks, including: ______________________________________________

Companionship and Support

 Companionship and conversation
 Appointment and activity scheduling
 Go for walks or spend time outdoors
 Social engagement, including: ________________________________________
 Other tasks, including: ______________________________________________

Other
 Other tasks, including: ______________________________________________

2. Employer and Employee understand that the Employee may complete additional tasks
as a part of their employment, that all time spent working must be compensated, and
that the above list of job responsibilities is not exhaustive.

III. Pay and Benefits

1. Employer agrees that Employee shall be paid at the following rates:
a. Hourly rate of pay per hour for non-overtime hours (must be at least the highest
applicable local, state, or federal minimum wage): $___________________

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
 b. Overtime rate of pay per hour for every hour (or fraction of every hour) worked
over 40 hours per week (at least 1.5x their hourly rate of pay) which must be
paid unless the employee is exempt under the Fair Labor Standards Act:
$____________
2. Employer agrees that the regular day(s) of payment and the means of payment to
Employee are as follows:
a. Payment by (check one):
 Cash
 Check
 Direct deposit
 Other form of payment: ____________________
b. The frequency of payment shall be (check one):
 Weekly on __________ (day of week)
 Bi-weekly on __________ (day of week) every two weeks
 Semi-monthly on __________ (date) and __________ (date) each month
 Other: ________________________________________
3. Employer shall provide the following additional benefit(s) to Employee (check all that
apply):
 Health insurance
 Dental insurance
 Reimbursement for health insurance premiums
 Retirement plan contributions
 Transportation allowance
 Additional benefits:
__________________________________________________________________
__________________________________________________________________
_________________________________________________________________
4. A pay statement will be provided to Employee on days of payment and will include the
following information (check all that apply):
 Name and address of the Employer
 Dates of the pay period for which Employee is paid
 Total hours worked
 Gross wages earned (i.e., amount Employee earns prior to deductions and taxes)
 All deductions and withholdings
 Net wages earned (i.e., amount Employee receives after deductions and taxes)
 Other:
__________________________________________________________________
__________________________________________________________________

IV. Taxes and Paycheck Deductions

1. The Employer will pay and withhold the legally required local, state, and federal taxes,
including Social Security and Medicare taxes, and all other legally required deductions.
2. At the Employee’s direction, the Employer will withhold __________________ (amount
or percentage) as the Employee’s income tax withholdings.

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
 3. Any additional deductions from the Employee’s wages must be mutually agreed upon
and consistent with applicable federal, state, and local laws, including section 3(m) of
the Fair Labor Standards Act which governs food, beverage, and lodging deductions. The
following deductions per ___________________ (pay period/month) shall be made:
a. Amount for health insurance, if applicable: $__________
b. Amount for food and beverages, if applicable: $__________
c. Amount for accommodations/lodging, if applicable: $__________
d. Amount for other deductions, if applicable: $__________

V. Schedule and Work Hours

1. ☐ Employer shall record all hours worked by the Employee, or ☐ the Employee shall
record all hours worked and report them to the Employer (check one). Employer will
keep all records in accordance with applicable law, including the Fair Labor Standards
Act.
2. Employee’s work schedule will be recorded below. If the Employee works any additional
amount in a particular workweek, that time will all be compensated at the appropriate
rate.

Day Start Time End Time # of Daily Hours

Sunday _____ AM/PM _____

_____ AM/PM

Monday _____ AM/PM _____

_____ AM/PM

Tuesday _____ AM/PM _____

_____ AM/PM

Wednesday _____ AM/PM _____

_____ AM/PM

Thursday _____ AM/PM _____

_____ AM/PM

Friday ______AM/PM _____

_____ AM/PM

Saturday _____ AM/PM _____ AM/PM _____

Total Hours Worked Per Week: _____

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
 3. If the Employee is expected to be “on call” for any hours during the week where they
must be immediately available or on-site, then the Employer agrees to pay the
Employee the appropriate rate (hourly rate or overtime pay) for those “on call” hours. If
Employee is expected to be “on call” on a regular basis, Employer will discuss this
expectation with the Employee and incorporate it into this agreement.
4. Employee shall have the following regular workday meal and rest breaks; Employer
acknowledges that short breaks (20 minutes or less) and longer breaks where the
Employee is not completely relieved from duty generally must be paid:

Break Type Duration Frequency Paid

(Meal/Rest/Other) (min) (per day)
(Specify the type of break) (Specify the (Specify the (Specify
duration by number of “Yes” or
minutes) times per day) "No”)

5. As part of the Employee’s workday, Employer and Employee will meet together on
___________________ (day of the week) for ___________________ (duration) to
communicate about any necessary planning and scheduling, what is going well and to
address any issues or conflicts that have arisen. Employer will encourage Employee to
raise concerns regarding any workplace or work-related hazards, unsafe conditions, and
any illnesses or injuries.
6. Employer agrees to provide Employee with reasonable break time to express breast milk
for their nursing child for one year after the child’s birth each time the Employee has
need to express milk, if needed. Additionally, the Employer agrees to provide a space to
pump that is free from intrusion and surveillance technology, shielded from view, and
not a bathroom.

VI. Cancellations, Schedule Changes, and Emergencies

1. If the Employer requests a schedule change or cancellation:
a. The Employer must provide the Employee notice of a schedule change or
cancellation at least _____________________ (time period) prior to the
scheduled work.
b. If notice of a schedule change or cancellation is within __________ (time period)
of scheduled work, then the Employer will (e.g., pay the worker in full for the
time they would have worked):
__________________________________________________________________
_________________________________________________________________
2. The Employer and Employee agree on the following processes for emergencies when
the Employee is not able to come in (i.e., severe weather):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
VII. Living Arrangement
1. The Employee and Employer agree that (check one option below):
 Option 1: Employee will live in the Employer’s home, residing on the premises
permanently or for extended periods of time (“Live-In”).
o Note: If “Option 1” is selected, good practices and legal requirements
regarding Live-In Employees are included on the DOL “Sample Agreements”
website.
 Option 2: Employee will not live in the Employer’s home.

VIII. Leave Benefits

1. Employer and Employee agree on the following policies regarding leave benefits, in
addition to compliance with any applicable federal, state, or local law regarding leave
benefits:

Type of Leave Policy Description

Sick Leave Compensation (check one): ☐ Paid or ☐ Unpaid
(e.g., Employee or How Leave is Earned:
their child is sick or  Employee will earn _____ hour(s) of sick leave for every ______
has a medical hour(s) of work, up to ______ days per calendar year.
appointment)  Employee will start every year with __________ hours of sick
leave that they may use throughout the year.
What the leave can be used for: ______________________________
Employee agrees to give Employer reasonable notice of intent to use
sick leave, when possible.
If unused, ___________ hours of sick leave can be carried over to the
next year.
Vacation Time Compensation (check one): ☐ Paid or ☐ Unpaid
(e.g., Employee’s How Leave is Earned:
time off for leisure)  Employee will earn _____ hour(s) of vacation leave for every
______ hour(s) of work, up to ______ days per calendar year.
 Employee will start every year with __________ hours of
vacation leave that they may use throughout the year.
Employee must notify Employer of intent to use vacation time within
____ days prior to taking leave.
If unused, ___________ hours of vacation leave can be carried over to
the next year.
Upon termination, _______ hours of unused paid vacation leave will be
paid to the Employee at a rate of $________ per hour.

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
 Caregiving and Compensation (check one): ☐ Paid or ☐ Unpaid
Medical Leave How Leave is Earned:
(e.g., Employee  Employee will earn _____ hour(s) of caregiving and medical leave
gives birth, needs for every ______ hour(s) of work, up to ______ days per calendar
to recover from year.
surgery, or their  Employee will start every year with __________ hours of
spouse has a caregiving and medical leave that they use throughout the year.
serious medical What the leave can be used for: ______________________________
condition) Amount of time required to give notice: _______________________

Employer agrees to comply with applicable federal, state, or local law

regarding paid or unpaid family and medical leave, including the federal
Family and Medical Leave Act.
Safe Leave (e.g., Employer will provide safe leave to the Employee due to situations that
Employee needs may arise related to gender-based violence, for up to a maximum of
time off to address _____ days per year. This leave will be ☐ Paid or ☐ Unpaid
intimate partner
violence)

Bereavement Employer will provide bereavement leave to the Employee in the event
Leave (e.g., of a death in the Employee's family for up to a maximum of _____ days
Employee needs per year. This leave will be ☐ Paid or ☐ Unpaid
leave to handle
matters related to
a death and to
grieve)

Other: Compensation (check one): ☐ Paid or ☐ Unpaid

________________ Amount of Leave: _________________________________________
________________ What the leave can be used for: ____________________________
Amount of time required to give notice: _______________________

2. Employer will provide the following holidays, which will be ☐ Paid or ☐ Unpaid:
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
3. For any above holidays that the Employee agrees to work, Employer will provide to the
Employee (e.g., premium pay, additional vacation leave, etc.):
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
IX. Workplace Health and Safety
1. Expectations around COVID-19 and other infectious diseases protocols, including
vaccinations, include:
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
2. Employer will obtain, as required by applicable law, workers’ compensation insurance or
the equivalent (e.g., through self-insurance or homeowner’s insurance) to cover wage-
loss and medical benefits, as appropriate, in the event that the Employee is injured or
sickened on the job (check one): ☐ Yes (Details of insurance: _____________________)
or ☐ No
3. Employer and Employee should identify risk factors that commonly contribute to work-
related injuries (e.g., use of chemicals, transfers, lifting, bending, repetitive motion,
slips, trips, and falls), and take steps to properly mitigate these factors.
4. Employer agrees to assess whether there is a potential risk of violence for the worker
from anyone in the home or neighborhood and, if applicable, develop a plan to mitigate
this risk.
5. Employer will ensure that training is provided to the Employee about the safe and
proper use of chemicals, any specialized tools, and personal protective equipment used
in the course of work.

X. Disability Accommodations
1. If applicable, Employer agrees to the following accommodations for the Employee due
to a temporary or permanent disability:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

XI. Supplies, Tools, and Personal Protective Equipment

1. Employer and Employee agree that supplies, tools, and appropriate personal protective
equipment (e.g., goggles, gloves, masks) for tasks that fall within the Employee’s
responsibilities described in Part II shall be obtained as follows (check one option
below):
 Option 1: Employer shall provide (and replace as appropriate) all necessary
supplies, tools, and properly fitting personal protective equipment at the
Employer’s expense.
 Option 2: If the Employee pays for any supplies, tools, and appropriate protective
equipment, then (check one):
 Employer shall give the Employee access to cash or funds for approved
purchases or emergencies.
 Employee should keep and submit all receipts, and the Employer shall
reimburse them within ___________ days.

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
XII. Workplace Dignity and Respect
1. Employer and Employee understand and agree to treat each other with respect and
dignity in all interactions and forms of communication. They also understand and agree
that discrimination, violence and harassment, including gender-based violence and
harassment, is prohibited. This prohibition applies to all members of the household and
guests and includes but is not limited to crude or sexual comments about appearance,
body, or clothes; pornographic or sexually explicit images; unwelcome or inappropriate
touching; sexual harassment, sexual assault, up to and including rape; threatening to
terminate employment or reduce pay if Employee refuses sexual advances; and making
sexist or derogatory comments based on gender. The Employee has the right to leave
employment if discriminated against, abused, harassed, or subject to violence.
2. Employer shall not retain Employee’s original documents or personal effects (e.g.,
passport, social security card, work visa, etc.).
3. Employer understands that it is illegal to retaliate against Employee for asserting their
rights under the Fair Labor Standards Act. Other laws may offer further protections
against retaliation. Employer also agrees not to retaliate against Employee for raising
concerns about possible violations of the terms of this contract.
4. The Employer understands that the Employee may be protected against discrimination
and other unfair employment practices under local, state, and federal labor and
employment laws regardless of race, sex, age, national origin, immigration status or
other protected class as defined by law.

XIV. Termination or Severance of Employment

1. If either the Employer or Employee chooses to end the working arrangement, the
terminating party will provide at least ________________ week(s) notice.
2. If the Employee is asked to leave before the end of the _________________week(s)
notice period, the employee will still be paid through the notice period, unless the
Employee is terminated for a reason listed below.
3. If the Employer decides to terminate the Employee (with or without advanced notice),
the Employer will provide ______________ week(s) of severance pay to the Employee
based on the number of years the Employee worked for the Employer (e.g., one week of
severance pay for each year of service). This will not apply in the case of immediate
termination for a cause mentioned below.
4. The Employer and Employee shall discuss situations that would be grounds for
immediate termination without advanced notice and list them here:
________________________________________________________________________
________________________________________________________________________

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
Agreement Signatures
The Employer(s) and Employee have signed below to indicate that they understand and agree
with the terms of the agreement above. (If there is more than one Employer, each Employer
and the Employee should sign the agreement below.)

Employer(s)
Signed name: __________________________________________________________________
Printed name: _________________________________________________________________
Date: ________________________________________________________________________

Employee
Signed name: __________________________________________________________________
Printed name: _________________________________________________________________
Date: ________________________________________________________________________

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.
 Additional Information for Household Employers and Home Care
Workers
Domestic work and the Fair Labor Standards Act:
The Department of Labor’s Wage and Hour Division (WHD) enforces federal labor standards, including
the federal minimum wage, overtime pay, recordkeeping, protections to pump breast milk at work, and
child labor requirements of the Fair Labor Standards Act (FLSA). Workers employed in domestic service
in private homes are covered by the FLSA. WHD has multiple resources for employees and employers,
including fact sheets and frequently asked questions here: https://www.dol.gov/agencies/whd/direct-
care/resources.

Resources for household employers who employ home care workers:

The WHD has numerous resources for individuals, families, and households who use home care services
to help them comply with their responsibilities under the FLSA.

These resources include a Home Care Guide explaining who must follow the FLSA rules, with examples
of situations involving hiring a home care worker directly, using a home care agency, and arranging care
through a Medicaid-funded self-directed program. The guide includes consideration of workers who are
family members of the employer and those who are live-in workers. The guide also explains how to
comply with the FLSA, including how to pay minimum wage and overtime, track hours worked, and keep
proper records. This guide can be found at: https://www.dol.gov/agencies/whd/direct-care/guide.

Depending on facts and circumstances, the provision of additional benefits under this written
employment agreement may result in the establishment by the employer of one or more employee
benefit plans (retirement plans, group health plans, and other welfare benefit plans) covered by the
Employee Retirement Income Security Act of 1974 (ERISA). Employers can learn more about ERISA’s
requirements for the administration and operation of employee benefit plans, including reporting,
disclosure, benefit claims procedure, fiduciary, and health benefit obligations, by visiting
https://www.dol.gov/agencies/ebsa/employers-and-advisers/small-business or calling 1-866-487-2365.

For additional employment compliance assistance resources for employers, please visit
www.employer.gov.

Resources for home care workers:

WHD has resources for home care workers to help them determine if they are entitled to federal labor
protections, including receiving at least the federal minimum wage and overtime. Those resources can
be found at: https://www.dol.gov/agencies/whd/direct-care/workers.

For additional information about workplace rights and resources for workers, please visit
www.worker.gov.

SAMPLE AGREEMENT DOES NOT REFLECT LEGAL OBLIGATIONS OR PROVIDE LEGAL ADVICE. IT IS INTENDED FOR
INFORMATIONAL PURPOSES ONLY AND IS NOT REQUIRED BY THE U.S. DEPARTMENT OF LABOR.