POEA E- REGISTRATION FORM: FIRST NAME CIVIL STATUS MIDDLE NAME RELIGION LAST NAME WEIGHT BIRTH DATE eet HEIGHT CELLPHONE NO. ADDRESS GENDER E-MAIL ADDRESS ADDRESS: Peomtl Recon fevte BUONG PANGALAN NG IYONG NANAY NUNG DALAGA PA SYA: apuyapo ne [MIDDLE NAME We aNay MUNG FIRST NAME amar WoWe Dalaca Pa Dauaca BENEFICIARIES (MAKIKINABANG) HIRST MIDDLENAME | LASTNAME | BIRTHDATE | RELATIONSHIP | CONTACT NO PASSPORT NO. DATE OF ISSUE | DATE OF TON WORK EXPERIENCEeee = LIGEISE NO POEAOETLBOt6IOR | - WP Sched, ‘Education / Training ‘Country “is, ies insbaind thy Sore = teil aes : aoe PERSONAL INFORMATION FAMILY BACKEROUND : Fut Ware Farner Full Nome sic ‘Occupation : pao ‘cy Address Motors Maiden Name “b-day Prov't, Address, : Occupation. Age os. Date of, No. ofboth A, Your aie the Won the araly to. of ters Zoe age Religion, Zodiac San, tnaitelsichE ings P-]Widow [female Parent Tet No, Mabie No. tod Cl sencratea [Notlegaliymontes Place of Bin eae Proce Mared, Date Mare aa Husband's Nome Helo Wolo, Passport No., Vale until eee 5 na Lenguages /Ditect Spoken, No.of Chien Boys ech ite reefs ~ehiereis Name EDUCATIONAL ATTAINMENT . : ‘SCHOOL WANE [ADI Temaniar Sena aM DOMESTIC HELPER WORK EXPERIENCE “T-Name of Employer Enigma Pores WRUOOT Wa Ib Tatonaliy. [eo From Le Salary Dut: No, of Famty amber) 5 No ora in he hus, Size of tho haves Eh Wo, etait, Ages Dining (00) Core ot Dead (Care of Newborn babea Rose G Cleaning Meshing &roning | G Gareotvoung Chiron, Aga © CarWesning © Coosing D Carsot Eker persons, Agate 1D erdonng| Chinese Food Bch Tuoi © torsing European Food Carat ets (pea, © Speak CantonasenMandorn 1 oer Lanauages amis stayin (WesINo?. Taino: Say Datos: (No.of Faily Members), No.of Maidsin te hour. ‘ ie ofthe house Wo, of Aas, Age's vg pect © cae or asaned {Care ofewibom nabies, Aaets © cienng e 1D Wasting &roning Care ot Young Chen ats 1 Garmshing Oi Coen Care ot Em persons, Ages alosuering | Chinese Food © | cna Tuer © tortetng 1. Exropean Food B_ Care of Pts pasty, 1 Speak Cantonssantandarn 1 oer Languages, Eider Woman's Condition, toms slayin (eee?) eee Sa eT “Ta He te a Cas ct aonb). te tent oes oes cee Selta tie 2 veiamer 3 ouaee Seen Gare of Young Cidren, Ages Car Washing D Cecking @ chamsy cen Stet S Sonat 8 ootee 8 Geers Bae D Speak CentoneseiManderin a ores ee item's siayin (Weenlo?) SS Waar 9NON-DOMESTIC HELPER WORK EXPERIENCE Rao rea ‘Name of Employer From: Te: Salary: Penaapersnaarear Raion Reason for Leaving ‘Name of Employer From: Le: Salary: | Enpyare Rares Postion Reason forLeavng OTHER RELEVANT INFORMATION WHAT ARE YOUR SPECIAL SIGLLS & HOBBIES?, ‘7 DOYOU HAVE RELATIVES ABROAD? WHO ARE THEM? WHAT COUNTRY? WHAT OCCUPATION? ¢ BO YOU HAVE CURRENT / ON-GOING APPLICATION IN OTHER AGENCIES? WHAT AGENCY?, CHARACTER REFERENCES / CONTACT PERSONS NAME COMP. & POSTION RELATIONSHIP CONTACT NOS. DECLARATION J hereby declare that all information given is certified true and correct. “APPLICANT'S SIGNATURE OVER PRINTED NAME FOR STAFF USE ONLY eee Seca seoweas Cee efter f = : | sien Tardiness Sasa “English Speaking bees) COMMUNICATION TABLE: REMARKS: DATE [THRU [— COMMUNICATION REMARKS | CFaameaak Hw m= EMPLOYMENT PARADISE SERIES Photo 2x2 PERSONAL DETAILS Employee's Name: Nationality: Faily Nae Fiestas ‘Hida Name Date of Birth: Place of Birth: Province: Contact Tel NoJs (Mobile): Residence) Languages Spoken: Height: Passport No. Dato of Issue: Expiration: Peron Single both status & passport Married but single passport Married both status & passport No. of Brothers/Sisters: No. of Children: Parent's age, Husband's age/ocoupation: You are the: Inthe family Elementary: ES Eero High Schoo: College/Lniversity: Degree: EMPLOYMENT HISTORYDeli d nen en Kol a4 1. DOMESTIC WORK EXPERIENCE (Please list the latest first) Name of Employer Nationality Salary Frm — acre “aor ‘ea Code: (__} ‘Contact No. Date of Employment Country No. of Aduttsielderly:_______No. of Children (age between 5 to 18) No. of Babies (age below 5): ‘When you start working When you start working ‘When you start working ages =] (1 (] (1) Aas : OOO ww: OOOO 2. DOMESTIC WORK EXPERIENCE Name of Empioyer Nationality ‘Salary ‘roa Code:(__) Country Contact No. BBR PANDO Date of Employment ™ No. of Adults/elderly:_______No. of Children (age between 5 to 18) No. of Babies (age below 5) ‘When you start working When you start working When you start working 3. DOMESTIC WORK EXPERIENCE aces :(—] 1 (1) (7) Ases ooo ws: OOOO Name of Employer Nationality Salary TRIB aren ‘rea Code: (_) Date of Employment Country ‘Contact No. No. of Adults/elderly:________No. of Children (age between 5 to 18): _______No. of Babies (age below 5): When you start working ‘When you start working When you start working 4. NON-DOMESTIC WORK EXPERTENCE Ages: ] (J) 2] 2) Aves : OOo aes: COCCI Name of Employer Nationality oor roe Date of Employment CountryMESSAGE TO YOUR EMPLOYER In your own hand writing. Is there any strength that you can convince the employer to hire you? Dear Employer, Hobbies: Special Skills: Signature SPECIALIZATION eee Care of Babies Tutoring Care of Young Children Cooking Care of Elderly Person Care of Pets Care of Disabled Person Doing the General Household16. 17 20. 24 34 18. 22. 23. 24, 25. 26. 27. 28. 20. 30. 32. Baby care (age 0-12 months) Changing the diaper Feeding the baby Bathe the baby Child care (over 3 years) Playing with the children Tutoring the children Special care for abnormalfretarded special children ‘Washing the clothes by hand Ironing the clothes Cooking chinese food Marketing . Caring the pets Gardening Driving Elderly care Elderly care (disabled) Elderly care (seri-disabled) WILLING & EXPERIENCE on C] ves CO ves CO ves CO ves CO ves CO ves Cl ves CO ves Co yes Cl yes CO ves (1 ves CJ no [no [no Cl yes (_] no Cves (] no Coves (1) no LC no CO ves NO. C1 xo [no [yo [yo Cino Cino C1 no (J no Cves (no Coves (1 no Co ves (J no Cives 1] no Cl yes ([] no CJ yes ([] no Coves (1) no Co ves (1) no Co ves (1 no Coves (1) no Co ves (J no C ves (3 ves (xo [1] xo Co ves (1) no (ves (1 no ves [no Cves FE] no RSONAL INFORMATION 19, Do you eat chinese food? Do you eat western food? ‘Are you wiling to share a room with babies/children? ‘Are you wiling to share a room with elderly person? ‘Are you willing to work with another domestic helper in Hong Kong? ‘Are you willing to take your day off set by your employer even it's not Sunday? ‘Are you willing to follow the code of discipline drawn up by your agency? ‘Are you wiling to perform multiple task in one time? ‘Are you afraid of dog or any pets? Do you smoke? Do you drink alcohol? Do you know how to drive? ‘Are you choosy about food? Do you have any allergies? CO ves [1] xo (ves (1 no Ci ves [1] no (ves (1 no (no Cno Cives (no Loves (1) no Clves [no 1 certify that all My statement in this Application for Employment is TRUE and CORRECT to the best of MY knowledge and belief. AGREE that, if gainfully employed, any misrepresentatio\s). V), and (or) omission of facts shall justly MY DISQUALIFICATION, DISMISSAL, or REPATRIATION from work Signature of Applicant