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CODE NO. 編 號 啟 路 人 力 公 司 CHERUB MANPOWER INCORPORATED 1569 COPERNICO ST., BGY. SAN ISIDRO, MAKATI CITY, PHILIPPINES Email: or .ph Website: .ph Tel: (+632) 7572378 (connecting all departments) / Fax: (+632) 7572379 女 傭 的 申 請 表 APPLICATION FORM FOR DOMESTIC/HOUSEHOLD WORKERS (Please fill-in this form in BLOCK-LETTERS format)申 請 日 DATE APPLIED護 照 號 碼 PASSPORTNO.姓 SURNAME名 GIVEN NAME(母) 姓 MIDDLE NAME通 訊 處 CITY ADDRESS電 話 TEL. NO.戶 籍 地 PROVINCIAL ADDRESS電 話 TEL. NO.生日DATE OF BIRTH出 生 地 點 PLACE OF BIRTH國 籍 NATIONALITY性 別 SEX宗 教 RELIGION年 齡 AGE身 高HEIGHT體 重 WEIGHT小孩人數 NO. OF CHILDREN他們的年齡 THEIR AGES婚 姻 狀 況 CIVIL STATUSSINGLE單身SINGLE PARENT單身父母MARRIED已婚SEPARATED離婚WIDOW寡婦SPOUSES NAME 配 偶 名 字OCCUPATION 工 作受 益 人 BENEFICIARY關 係 RELATIONSHIPFATHERS NAME父 親 的 名 字年 齡 AGEOCCUPATION 工 作MOTHERS NAME 母 親 的 名 字年 齡 AGEOCCUPATION 工 作NO.OF BROTHERS兄 弟 人 數 THEIR AGES他 們 的 年 齡NO.OF SISTERS姐 妹 人 數THEIR AGES他 們 的 年 齡教 育 狀 況 EDUCATIONAL ATTAINMENT完 成 的 COURSE(s)校 名 NAME OF SCHOOL年 YEAR學 歷 COMPLETED自FROM至 TO小 學 ELEMENTARY中 學 HIGH SCHOOL大 學 COLLEGE/COURSE職 業 培 訓 VOCATIONAL其 它 學 校 OTHERS工 作 經 驗 WORK EXPERIENCE(List of all working experience starting from the most recent)自FROM至 TO公 司 / 雇 主 名 稱 NAME OF COMPANY/EMPLOYER職 位POSITION工 作 範 圍DUTIES & RESPONSIBILITIES(1)REMARKS 評 論 SALARY 薪 水(2)REMARKS 評 論 SALARY 薪 水(3)REMARKS 評 論 SALARY 薪 水(4)REMARKS 評 論 SALARY 薪 水State your priority by numbering from 1 to 10, what you do best, second best, etc.: 請 按 照 您 的 專 長 工 作 填 寫 下 列 項 目 (1-10)Cooking烹 煮Baby Care 嬰 兒 護 理Gardening清 潔 家 園Child Care小 孩 護 理Cleaning 清 潔 家 裡Ironing燙 衣Geriatric Care 病 人 護 理Laundry 洗 衣Tutoring輔 導Care of Disabled 臥 病 護 理 Languages Spoken 語 言PERSONAL QUESTIONS(Please read carefully and be honest in giving your answers)1. Would you be willing to accept the “NO-DAY-OFF” policy of your employer?YESNO2. Are you willing to accept and take your “DAY-OFFs” set by your employer?YESNO3. Are you prepared NOT to use the telephone without permission or consent of your employer?YESNO4. Would you be willing and able to follow the all rules and regulations in the house set by your employer?YESNO5. Would you promise NOT to invite your friends/relatives in your employers residence without their permission/consent?YESNO6. Do you smoke? If yes, how many packs or sticks a day? _ packs _ sticksYESNO7. Do you drink? If yes, is it light? _ moderate? _ heavy? _YESNO8. Have you ever experienced taking drugs before? If yes, please specify what kind: _YESNO9. Are you under medication? If yes, please specify: _YESNO10. Do you have any physical defects/disabilities/sickness? If yes, pls. specify: _YESNO11. Have you suffered from any serious illness before? If yes, pls. specify: _YESNO12. Have you undergone any operations for the last twelve (12) months? If yes, pls. specify: _YESNO13. Do you suffer from any forms of allergy? If yes, pls. specify: _YESNO14. Would you be willing and/or able to handle taking care of pets? If yes, pls. specify: _YESNO15. Can you promise to finish your contract in, say, three (3) years?YESNO16. Can you promise to be good to your employer and/or any immediate member(s) of his family?YESNO17. Do you promise NOT take any salary advances from your employer, no matter what the circumstances may be?YESNO18. Do you promise not to run-away from your employer?YESNO19. Can you promise not to go out from your employers house without his permission or consent?YESNO20. Can you promise not to touch anything that is not yours, whether or not it is in your employers house or another place of residence or place and that you will immediately and honestly report something that you might have found lying around?YESNOCAN YOU HANDLE THE FOLLOWING? - PLEASE TICK YOUR ANSWERS BELOWELECTRICAL HOME APPLIANCESHOUSEHOLD CHORESBABY/PEDIATRIC CAREWashing MachineYesNoCleaningYesNoBathingYesNoRice CookerYesNoWashingYesNoChanging ClothesYesNoDish DrainerYesNoIroningYesNoChanging DiapersYesNoVacuum CleanerYesNoCookingYesNoFeedingYesNoFloor polisherYesNoGardeningYesNoNurturingYesNoMicrowave OvenYesNoCar WashingYesNoBedtime CareYesNoOven ToasterYesNoMarketingYesNoBaby MassageYesNoOthers: _YesNoOthers: _YesNoOthers: _YesNoCHILD/INFANT CAREGERIATRIC/OLD & INVALID CAREBEDRIDDEN CASES CAREBathingNoBathingYesNoBed BathYesNoChanging ClothesYesNoChanging ClothesYesNoHair ShampooingYesNoChanging DiapersYesNoChanging DiapersYesNoChanging DiapersYesNoOral FeedingYesNoOral FeedingYesNoTube FeedingYesNoNurturingYesNoNurturingYesNoNurturingYesNoBedtime CareYesNoMassagingYesNoMassagingYesNoOthers: _YesNoOthers: _YesNoOthers: _YesNoADDITIONAL PERSONAL QUESTIONS (please answer them with all honesty)a.Why do you want to work abroad?b.In your opinion, what are the real qualities of a domestic helper/worker (or caregivers/caretakers)? To your mind, what are they really?c.What foreign dish(es) can you cook?ChineseJapaneseItalianWesternOthersCan you specify or list any of them?d.Do you know anyone at the country you are going? If yes, please give some details as to their:NameNationalityAddressNameNationalityAddressYOUR PORTRAIT-SIZED PICTURE BELOWPlease write a nice personal note below for your prospective employer to read about you:DECLARATION:I hereby affirm that all the information above were true; andThat, I shall undergo the required medical & trade test exams at my own expense;That, the act of filing of such application & the required travel documents I submitted does not assure an immediate employment but a mere application for overseas employment;That, upon acceptance by the employer I shall pay the required placement fee;That, if I withdraw my application, I shall pay a withdrawal fee to cover any and all administrative cost
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