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| Personal Data 個人紀錄 | |||||
| Name | 姓名 | GERLIE | |||
| Date of Birth | 出生日期 | 1994 | Age | 年齡 | 30 |
| Place of Birth | 出生地點 | STO TOMAS DAVAO | Sex | 性別 | F |
| Chinese Horoscope | 生肖 | Dog | Education | 學歷 | Senior High School |
| Religion | 宗教 | Christian | Weight | 體重 | 62 kg |
| Marital Status | 婚姻狀況 | Single | Height | 高度 | 158 cm |
| Address | 地址 | ||||
| Family Background 家庭背景 | |||||
| Father's Name | 父親姓名 | Occupation | 父親職業 | ||
| Mother's Name | 母親姓名 | Occupation | 母親職業 | ||
| Name of Spouse | 配偶姓名 | Occupation | 配偶職業 | ||
| No. of Sister | 姊妹數目 | No. of Children | 子女數目 | ||
| No. of Brother | 兄弟數目 | 3 | Ages of Children | 子女年齡 | |
| In the Family, I am No | 在家排行 | 2 | |||
| Experienced in Following Countries 海外經驗 | |||||
| Hong Kong 香港 | Malaysia 馬來西亞 | Indonesia 印尼 | |||
| Singapore 新加坡 | Middle East 中東 | 3YRS | Philippines 菲律賓 | 2YRS | |
| Taiwan 台灣 | Other 其他 | ||||
| Interview Appraisal 面試評價 | ||||||
| 差 Poor |
平 Average |
好 Good |
優 Excellent |
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| Babies Caring 護理嬰兒 |
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| Children Caring 護理兒童 |
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| Care of Elder/Disabled 護理老人/傷殘 |
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| Household Works 家務 |
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| Cooking 烹飪 |
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| Care of Pets 照顧寵物 |
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| Spoken English 能操英語 |
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| Spoken Cantonese 能操廣東話 |
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| Spoken Mandarin 能操普通語 |
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| Remarks 備註 |
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| Domestic Employment Records 工作紀錄 (Form recent year on work 由最近期開始) |
| 1. Country 國家 | Nationality of Employer 僱主國籍 | From DD/MM/YYYY 由 | To DD/MM/YYYY 至 |
| KUWAIT | KUWAITE | 2019-08 | 2022-08 |
| Care of new-born babies 照料初生嬰兒 | Ages 歲數 | ||
| Care of young children 照顧小孩 | Ages 歲數 | 2YRS OLD GIRL | |
| Care of adults 照顧成人 | Ages 歲數 | SIR, MADAM | |
| Care of elderly 照顧老人 | Ages 歲數 | ||
| Care of disabled 照顧傷殘 | Ages 歲數 | ||
| Care of pets 照顧寵物 |
| House Cleaning 清潔房屋 | Doing the laundries 洗衫 | Ironing 熨衫 | |||
| Cooking 烹飪 | Chinese Food 中國菜 | Western Food 西餐 | |||
| Car Washing 洗車 | Marketing 買餸 | Other 其他: |
| 2. Country 國家 | Nationality of Employer 僱主國籍 | From DD/MM/YYYY 由 | To DD/MM/YYYY 至 |
| PHILIPPINES | FILIPINO | 2015 | 2017 |
| Care of new-born babies 照料初生嬰兒 | Ages 歲數 | ||
| Care of young children 照顧小孩 | Ages 歲數 | 3YRS OLD BOY | |
| Care of adults 照顧成人 | Ages 歲數 | SIR, MADAM | |
| Care of elderly 照顧老人 | Ages 歲數 | ||
| Care of disabled 照顧傷殘 | Ages 歲數 | ||
| Care of pets 照顧寵物 |
| House Cleaning 清潔房屋 | Doing the laundries 洗衫 | Ironing 熨衫 | |||
| Cooking 烹飪 | Chinese Food 中國菜 | Western Food 西餐 | |||
| Car Washing 洗車 | Marketing 買餸 | Other 其他: |
| 3. Country 國家 | Nationality of Employer 僱主國籍 | From DD/MM/YYYY 由 | To DD/MM/YYYY 至 |
| Care of new-born babies 照料初生嬰兒 | Ages 歲數 | ||
| Care of young children 照顧小孩 | Ages 歲數 | ||
| Care of adults 照顧成人 | Ages 歲數 | ||
| Care of elderly 照顧老人 | Ages 歲數 | ||
| Care of disabled 照顧傷殘 | Ages 歲數 | ||
| Care of pets 照顧寵物 |
| House Cleaning 清潔房屋 | Doing the laundries 洗衫 | Ironing 熨衫 | |||
| Cooking 烹飪 | Chinese Food 中國菜 | Western Food 西餐 | |||
| Car Washing 洗車 | Marketing 買餸 | Other 其他: |
| Duties I Can Do Best 我最擅長之工作 | |||||
| Care of new-born babies 照料初生嬰兒 | Cleaning 清潔 | Washing 洗衫 | |||
| Care of young children 照顧小孩 | Cooking 煮食 | Ironing 熨衫 | |||
| Care of elderly person 照顧老人 | Care of Pets 照顧寵物 | ||||
| Care of Disabled 照顧傷殘人士 | Gardening 打理花園 | ||||
| Tutoring Children English or simple homework 教授小孩 | |||||
| Supplementary Questions 附加問題 | Yes Yes | No No | ||
| 1. | Do you smoke or drink alcohol ? 你是否吸煙或喝酒? |
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| 2. | Can you drive? 你會否駕駛? |
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| 3. | If your holiday not on Sunday do you agree? 若假期不在星期日，你是否願意? |
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| 4. | Do you have an infection skin disease? 你有沒有感染的皮膚病? |
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| 5. | Are you willing to take care of children no matter how many the family has? 無論僱主有多少個孩子，你也願意照顧? |
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| 6. | Do you have all complete and normal body? 你有完整和正常身體? |
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| 7. | Do you have a criminal record or is the Labor Department record of case follow-up? 你有沒有犯案記錄 或 勞工處記錄案件跟進嗎? |
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| 8. | Living with elderly person? 你願意與長者生活？ |
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| 9. | Are you willing to work for a family without your own room? 你是否願意沒有自己的獨立房間？ |
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| 10. | If your employer asked you to work on your holidays and is willing to pay compensation, are you willing to
do so? 如果你的老闆要求你的假期需要工作，並願意賠償，你是否願意這樣做呢？ |
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| 11. | Do you eat pork? 你會否食豬肉? |
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| 12. | Can you handle pork? 你能否烹調豬肉菜式? |
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| 13. | Are you afraid of dogs? 你怕狗嗎？ |
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| 14. | Are you willing to take care of dogs? 你願意照顧狗隻嗎? |
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| 15. | Are you willing to work with other helper? 你願意與其他傭人一起工作? |
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| 16. | Are you willing to take care of disabled elderly, help them to take a bath, change diaper,
help them to go to toilet, and accompany to hospital? 你是否願意照顧傷殘老人，幫助他們洗澡，換尿片，大小便及到醫院? |
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| 17. | Do you have any long-term illnesses and need to take medicine on a regular basis? 你有冇長期病患及需要定時吃藥? |
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Declaration by Applicant
| I agree and will be responsible for any publication of above information. I hereby confirm that all information and answer give to me is to the best of my knowledge. “The applicant gives all information with No responsibility holding by Maidsmore Employment Agency Limited.” “以上資料由申請者提供, 任何法律責任與本公司無關。” |
| Signature of Applicant: | Date: |