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Name :
Ref. Code :
Type :
Select
New
Transfer
Ex-Singapore
Ex-Abroad
Publish :
Select
Yes
No
Maid Status :
Select
Unemployed
Reserved
Booked
Employed
Repatriated
Availability :
Has Photo? :
Has Video? :
Personal
Nationality :
Select
Filipino
Indonesian
Indian
Sri Lankan
Bangladeshi
Thai
Myanmarese
Cambodian
Mizoram
Date of Birth :
Place of Birth :
Number of Siblings :
Number of Children :
Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Ages :
Height :
cm
ft
in
Weight :
kg
lbs
Religion :
Select
Christian
Catholic
Buddhist
Muslim
Hindu
Skih
Others
Marital Status :
Select
Single
Married
Widowed
Divorced
Separated
Education :
Select
Secondary (8-9 years)
High School ( 10-12 years)
College ( 13 years or more)
Education info :
Basic salary (S$) :
Preference for rest day :
Select
0
1
2
3
4
Passport No. :
Passport Expiry :
Work Permit No. :
Work Permit Expiry:
Home Address. :
Home Number :
Repatriate (Air)Port :
Interview
Avaliability of FDW To Be Interviewed By Prospective Employer
FDW is not available for interview
DW can be interviewed by video-conference
FDW can be interviewed by phone
FDW can be interviewed in person
Method of Evaluation of Skills
Based on FDW's declaration, no evaluation/observation by Singapore EA or overseas training center/EA
interviewed by Singapore EA
... interviewed via telephone/teleconference
... interviewed via videoconference
... interviewed in person
... interviewed in person and also made observation of FDW in the areas of work listed in table
interviewed by overseas training center/EA
... interviewed via telephone/teleconference
... interviewed via videoconference
... interviewed in person
... interviewed in person and also
Language
Spoken Language
Experience
Assessment
N.A. ... Poor ... Excellent
Observation
English
yr
Mandarin/Chinese-Dialect
yr
Bahasa Indonesia/Malaysia
yr
yr
Spoken Language
English
Experience
yr
Assessment
N.A. ... Poor ... Excellent
Observation
Spoken Language
Mandarin/Chinese-Dialect
Experience
yr
Assessment
N.A. ... Poor ... Excellent
Observation
Spoken Language
Bahasa Indonesia/Malaysia
Experience
yr
Assessment
N.A. ... Poor ... Excellent
Observation
Spoken Language
Experience
yr
Assessment
N.A. ... Poor ... Excellent
Observation
Skills
Areas of Work
Willingness & Experience
Assessment
N.A. ... Poor ... Excellent
Observation
Care for Infant/Children
yr
mo
Care for Elderly
yr
mo
Care for Disabled
yr
mo
General Housework
yr
mo
Cooking
yr
mo
yr
mo
Infant/children Age Range :
Areas of Work
Care for Infant/Children
Willingness & Experience
yr
mo
Assessment
N.A. ... Poor ... Excellent
Observation
Areas of Work
Care for Elderly
Willingness & Experience
yr
mo
Assessment
N.A. ... Poor ... Excellent
Observation
Areas of Work
Care for Disabled
Willingness & Experience
yr
mo
Assessment
N.A. ... Poor ... Excellent
Observation
Areas of Work
General Housework
Willingness & Experience
yr
mo
Assessment
N.A. ... Poor ... Excellent
Observation
Areas of Work
Cooking
Willingness & Experience
yr
mo
Assessment
N.A. ... Poor ... Excellent
Observation
Areas of Work
Willingness & Experience
yr
mo
Assessment
N.A. ... Poor ... Excellent
Observation
Infant/children Age Range :
Other Info
Able to handle pork?
Yes
No
Able to eat pork?
Yes
No
Able to handle beef?
Yes
No
Able to care dog/cat?
Yes
No
Able to do gardening work?
Yes
No
Able to do simple sewing?
Yes
No
Willing to wash car?
Yes
No
Willing to work on off days with compensation?
Yes
No
Willing to work with other helper?
Yes
No
Willing to share room?
Yes
No
Other food handling preferences :
Experience
Home Country
yr
mo
Singapore
yr
mo
Care for Disabled
yr
mo
Malaysia
yr
mo
Hongkong
yr
mo
Taiwan
yr
mo
Middle East
yr
mo
Other Countries
yr
mo
Introduction
Medical
Allergies :
Physical disabilities :
Dietary restrictions :
Any Other Remarks :
Past and existing illnesses
Mental Illnesses
Yes
No
Epilepsy
Yes
No
Asthma
Yes
No
Diabetes
Yes
No
Hypertension
Yes
No
Tubercuiosis
Yes
No
Heart disease
Yes
No
Malaria
Yes
No
Operation
Yes
No
(other)
Employment
From
To
Country
Employer
Work Duties
Remarks
1
2
3
4
5
1
From
To
Country
Employer
Work Duties
Remarks
2
From
To
Country
Employer
Work Duties
Remarks
3
From
To
Country
Employer
Work Duties
Remarks
4
From
To
Country
Employer
Work Duties
Remarks
5
From
To
Country
Employer
Work Duties
Remarks
Feedback
Employer
Feedback
1
2
3
4
5
1
Employer
Feedback
2
Employer
Feedback
3
Employer
Feedback
4
Employer
Feedback
5
Employer
Feedback
Remark (internal)