APPLICATION FORM
FOR DOMESTIC/HOUSEHOLD WORKERS
(Please fill-in this form in BLOCK-LETTERS format)
DATE APPLIED / AUGUST 08, 2017 / PASSPORT NO. / EC7805396LINDAYAO / LOUELA / DALAGUIT
SURNAME / GIVEN NAME / MIDDLE NAME
CITY ADDRESS / BLK 7 LOT 70 GREEN MARK HOMES 2 / TEL. NO. / 09979587329
PROVINCIAL ADDRESS / MALAGASANG 2-B IMUS CITY CAVITE / TEL. NO. / 09982054936
DATE OF BIRTH / AUGUST 19, 1981 / PLACE OF BIRTH / HIBAIYO NEG. OR.
ΝΑΤΙΟΝΑLITY / FILIPINO / SEX / FEMALE / RELIGION / CATHOLIC / AGE / 36
HEIGHT / 5’2” / WEIGHT / 53KGS / NO. OF CHILDREN / 2 / THEIR AGES / 16,15
FAMILY STATUS
SINGLE / SINGLE PARENT / P / MARRIED / SEPARATED / WIDOW
SPOUSE’S NAME / OCCUPATION
BENEFICIARY / PATRICK LOUIE LINDAYAO
PAT LESTER LINDAYAO / RELATIONSHIP / SONS
FATHER’S NAME / RONALDO LINDAYAO SR / AGE / 59 / OCCUPATION / CARPENTER
MOTHER’S NAME / LEONILA LINDAYAO / AGE / 56 / OCCUPATION / HOUSEWIFE
NO. OF BROTHERS / 1 / THEIR AGES / 34 / NO. OF SISTERS / 1 / THEIR AGES / 37
ACADEMIC QUALIFICATIONS
COURSE(s)
COMPLETED / ΟΝΟΜΑ ΤΟΥ ΣΧΟΛΕΙΟΥ/NAME OF SCHOOL / YEAR
FROM / TO
ELEMENTARY / SAN ELEMENTARY SCHOOL / 1994 / 1995
HIGH SCHOOL / CALATRAVA / 1998 / 1999
COLLEGE/COURSE
UNIVERCITY/COURSE
VOCATIONAL
OTHERS
ΕΠΑΓΓΕΛΜΑΤΙΚΗ ΕΜΠΕΙΡΙΑ/WORK EXPERIENCE
(List of all working experience starting from the most recent)
FROM / TO / (1) NAME OF COMPANY/EMPLOYER/
COUNTRY / POSITION / DUTIES&RESPONSIBILITIES
2007 / 2009 / 7 ELEVEN /TERESITA NATIVIDAD PHILIPPINES / SALES CLERK
REMARKS / SALARY
FROM / TO / (2) NAME OF COMPANY/EMPLOYER / POSITION / DUTIES&RESPONSIBILITIES
2009 / 2012 / DIMSUM N DUMPLINGS
MICHAEL CHUA/PHILIPPINES / SERVICE CREW
REMARKS / SALARY
FROM / TO / (3) NAME OF COMPANY/EMPLOYER / POSITION / DUTIES&RESPONSIBILITIES
2012 / 2016 / NEOFYTTOUS TTOFOURIS/CYPRUS
SOPHIA ANDREOU / CARING OLD PEOPLE
REMARKS / SALARY
FROM / TO / (4) NAME OF COMPANY/EMPLOYER / POSITION / DUTIES&RESPONSIBILITIES
REMARKS / SALARY
State your priority by numbering from 1 to 10, what you do best, second best, etc.
Cooking / 3 / Baby Care / 6 / Gardening / 8 / Child Care / 5 / Cleaning / 2
Ironing / 7 / Geriatric Care / 8 / Laundry / 4 / Tutoring / 10 / Care of Disabled / 1
Languages Spoken
PERSONAL QUESTIONS
(Please read carefully and be honest in giving your answers)
1. Would you be willing to accept the «ΝΟ—DAY-OFF» policy of your employer? / YES / NO / ü
2. Are you willing to accept and take your «DAY-OFF’s» set by your employer? / YES / ü / NO
3. Are you prepared NOT to use the telephone without permission or consent of your employer? / YES / ü / NO
4. Would you be willing and able to follow the all rules and regulations in the house set by your employer? / YES / ü / NO
5. Would you promise NOT to invite your friends/relatives in your employer’s residence without their permission/consent? / YES / ü / NO
6. Do you smoke? If yes, how many cigarettes per day? ______ / YES / NO / ü
7. Do you drink? If yes, is it light? ______moderate? ______heavy? ______ / YES / NO / ü
8. Have you ever experienced taking drugs before? If yes, please specify what kind ______ / YES / NO / ü
9. Are you under medication? If yes, please specify:______ / YES / NO / ü
10. Do you have any physical defects/disabilities/sickness? If yes, please specify:______ / YES / NO / ü
11. Have you suffered from any serious illness before? If yes, please specify: ______ / YES / NO / ü
12. Have you undergone any operations for the last twelve (12) months? If yes, please specify: ______ / YES / NO / ü
13. Do you suffer from any forms of allergy? If yes, please specify:______ / YES / NO / ü
14. Would you be willing and/or able to handle taking care of pets? If yes, please specify: ______ / YES / ü / NO
15. Can you promise to finish your contract in, say, four (4) years? / YES / ü / NO
16. Can you promise to be good to your employer and/or any immediate member(s) of his family? / YES / ü / NO
17. Do you promise NOT take any salary advances from your employer, no matter what the circumstances may be? / YES / ü / NO
18. Do you promise not to run-away from your employer? / YES / ü / NO
19. Can you promise not to go out from your employer’s house without his permission or consent? / YES / ü / NO
20. Can you promise not to take anything that is not yours, whether or not it is in your employer’s house or another place of residence or place – and that you will immediately and honestly report something that you might have found lying around? / YES / ü / NO
CAN YOU HANDLE THE FOLLOWING? – PLEASE TICK YOUR ANSWERS BELOW
ELECTRICAL HOME APLIANCES / HOUSEHOLD CHORES / BABY/PEDIATRIC CARE
Washing
Machine / Yes / √ / No / Cleaning / Yes / √ / No / Bathing / Yes / √ / No
Rice cooker / Yes / √ / No / Washing / Yes / √ / No / Changing Clothes / Yes / √ / No
Dish Drainer / Yes / √ / No / Ironing / Yes / √ / No / Changing
Diapers / Yes / √ / No
Vacuum Cleaner / Yes / √ / No / Cooking / Yes / √ / No / Feeding / Yes / √ / No
Floor polisher / Yes / √ / No / Gardening / Yes / √ / No / Nurturing / Yes / √ / No
Microwave Oven / Yes / √ / No / Car Washing / Yes / √ / No / Bedtime Care / Yes / √ / No
Oven Toaster / Yes / √ / No / Shopping / Yes / √ / No / Baby Massage / Yes / √ / No
Others: ______ / Yes / No / Others:
______ / Yes / No / Others:
______ / Yes / No
CHILD/INFANT CARE / GERIATRIC/OLD & INVALID CARE / BEDRIDDEN CASES CARE
Bathing / Yes / √ / No / Bathing / Yes / √ / No / Bed Bath / Yes / √ / No
Changing Clothes / Yes / √ / No / Changing Clothes / Yes / √ / No / Hair Shampooing / Yes / √ / No
Changing
Diapers / Yes / √ / No / Changing
Diapers / Yes / √ / No / Changing
Diapers / Yes / √ / No
Bottle Feeding / Yes / √ / No / Bottle Feeding / Yes / √ / No / Tube Feeding / Yes / √ / No
Nurturing / Yes / √ / No / Nurturing / Yes / √ / No / Nurturing / Yes / √ / No
Bedtime Care / Yes / √ / No / Massaging / Yes / √ / No / Massaging / Yes / √ / No
Others: ______ / Yes / No / Others:
______ / Yes / No / Others:
______ / Yes / No
ADDITIONAL 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 these qualities?
c / What foreign dish(es)
can you cook? / Chinese / Japanese / Italian / Western / Others
Can you specify or list any of them?
CYPRUS FOOD
d / Do you know anyone at the country you are going? If yes, please give some details as to their:
Name / Nationality
Address
Name / Nationality
Address
YOUR PORTRAIT-SIZED PICTURE BELOW / Please 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; and
That, I shall undergo the required medical and trade test exams at my own expense;
That, the act of filling of such application and 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 be the one to shoulder my expenses of my documents;
That, if I withdraw my application, I shall pay a withdraw fee to cover any and all administrative costs, paper works and time consumed;
That, in three (3) months after my employment, I shall not hold ……………… Agency liable for any violation of my contract of employment and
That, in any mis-declaration or misinterpretation I may have written/ stated herein can become a just cause for my immediate dismissal in my employment in the future.
I ALSO HEREBY ATTEST THAT I am aware of the offered salary for the above position as stated above, and that I voluntarily, and on my own will, will accept the said salary should I be hired.
Date applied: / SignatureINTERVIEWR’S REMARKS
NOT FOR SALE
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