QUALITY-TRAINED Ref TBSK240 IB

DOMESTIC MAIDS ATTACH 4 PASSPORT

SIZE PHOTOGRAPHS

SERTAKAN 4 KEPING
GAMBAR PASSPORT

PERSONAL PARTICULARS (BUTIR-BUTIR PERIBADI)

Name / Nama D.O.B / Tarikh Lahir Age / Umur
DINA EKAWATI 05 JANUARI 1984 28 YO

Marital status / Taraf Kahwin Ht / Tinggi Wt / Berat Birth Place / Tempat Lahir
SINGLE 153 CM 42 KG BANYUWANGI

Children’s Age / Umur Anak-Anak Race / Suku Kaum Religion / Agama Nationality / Warganegara
BOYS / Laki-laki : ( YO) JAWA HINDI INDONESIAN

GIRLS / Perempuan : ( YO)

Siblings Age / Umur Adik Beradik NAME / Nama: (Age/Umur)
Boys / Laki-laki : ( YO ) Husband / Suami : ( YRS )
Girls / Perempuan : ( YO)
Father / Bapa : SUNGKONO ( 45 YRS )
You are No. what ?/Awak anak keberapa:
Mother / Emak : NGATIWI ( 41 YRS )
Next of Kin Hubungan Penjaga: MOTHER
Home Address (Next-of-Kin) / Alamat Rumah (Suami/Bapa/Emak) Tel. No. / Bil. Tel Last Job / Kerja Terakhir
DSN SUMBERKEMBANG BARAT RT O2/01 KEC TEGALSARI -
KAB BANYUWANGI JAWA TIMUR
AGENCY USE / KEGUNAAN AGEN PHOTOGRAPH / GAMBAR
Passport No. / No. Paspot Issue date / Tarikh keluar

Issued at / Tempat keluar Expiry date/Tarikh Luput

Education Level / Tahap Pelajaran

SMP
Language Proficiency Written Spoken
(Kecekapan Berbahasa) (Tulis) (Cakap)
Indonesian / Indonesia : GOOD GOOD

English / Inggeris : POOR POOR

Mandarin / Mandarin : POOR POOR

COMPLEXION / WAJAH
Dark /
Gelap X Tanned /
Perang
Fair /
Cerah

Preferences of Work / Kercenderungan Bidang Kerja

Baby and Children Care / Cooking /

1 Menjaga Bayi dan Kanak 2 Memasak

Taking Care of General Housework

4 Aged /Menjaga 1 / Kerja Rumah
Orang Tua
 QUESTIONNAIRE / DAFTAR PERTANYAAN
Can you do simple sewing such as sewing of buttons, torn clothes etc…?
1. YES
Bolihkah anda menjahit pakai tangan saperti jahit butang, pakaian tertetas dsb.?
Can you sweep and mop the floor?
2. YES
Bolihkah anda menyapu dan mop lantai?
Can you iron clothes?
3. YES
Bolihkah anda menyetrika pakaian?
Can you handle and cut pork?
4. YES
Bolihkah anda memegang dan memotong daging babi?
Do you eat pork?
5. YES
Adakah anda makan daging babi ?
Can you cook? State details…
6. YES
Bolihkah anda masak? (masakan Indonesia)
Are you willing to bathe a baby if taught how to do so by the employers?
7. YES
Sanggupkah anda mandikan bayi jika di tunjuk ajar caranya oleh majikan?
Are willing to take care of babies and kids?
8. YES
Sanggupkah anda menjaga bayi dan kanak-kanak?
Are you willing to fetch children to and from school?
9. YES
Sanggupkah anda menjemput dan menghantarkan anak-anak kesekolah?
Are you willing to look after a semi-invalid / aged person?
10. YES
Sanggupkah anda menjaga orang yang kurang berupaya / tua?
Are you willing to take care of dogs, cats or other domestic pets?
11. NO
Sanggupkah anda menjaga anjing, kucing atau binatang peliharaan yang lain?
Do you smoke and/or consume alcoholic drinks?
12. NO
Adakah anda merokok dan/atau minum minuman keras?
Are you afraid of being left alone in the house?
13. NO
Takutkah anda jika ditinggalkan bersendirian dirumah?
Are you prepared to work for a Non Muslim Employer?
14. YES
Sanggupkah anda bekerja untuk majikan yang bukan berugama Islam?
Are you willing to be responsible for all work assigned to you?
15. YES
Sanggupkah anda bertanggunjawab keatas semua kerja yang di amanahkan?
Are you willing to obey rules and follow instructions from your employers?
16. YES
Sanggupkah anda patuhi peraturan dan ikut arahan para majikan?
Can you pray, recite the Quran…..
17. NO
Bolihkah anda sholat, mengaji….. ( Bisa Mengaji & Sholat )
Have you ever worked in Singapore using a different NAME and/or PASSPORT?
18. NO
Pernahkah anda bekerja di Singapura dengan NAMA dan/atau PASPOT lain?
RELEVANT EXPERIENCE / PENGALAMAN BERKAITAN
IN / DENGAN AS / SEBAGAI WHERE? / DIMANA? PERIOD / TEMPOH
GENERAL HOUSEWORK
(KERJA RUMAH UMUM) DI SPORE 2007-2009
COOKING
(MASAK)
JAGA BABY
BABY-CARE, CHILD-CARE
(MENJAGA BAYI, ANAK)
TAKING CARE OF AGED
(MENJAGA ORANG TUA)
OTHERS
(LAIN-LAIN)
ADDITIONAL INFORMATION / MAKLUMAT SAMPINGAN
DINA EKAWATI Signature Of
Applicant

__________________________
Signature of Interviewer