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APPLICATION FORM

FOR DOMESTIC/HOUSEHOLD WORKERS

(Please fill-in this form in BLOCK-LETTERS format)

DATE APPLIED / MARCH 05, 2018 / PASSPORT NO. / P4068673A
CARIGMA / ROSS ANNE / HALILI
SURNAME / GIVEN NAME / MIDDLE NAME
CITY ADDRESS / 715 M. CRUZ ST. GUILLERMO MORONG RIZAL / TEL. NO. / 09774069028
PROVINCIAL ADDRESS / TEL. NO.
DATE OF BIRTH / OCTOBER 15, 1980 / PLACE OF BIRTH / MORONG RIZAL
ΝΑΤΙΟΝΑLITY / FILIPINO / SEX / FEMALE / RELIGION / CATHOLIC / AGE / 37
HEIGHT / 5” / WEIGHT / 57KGS / NO. OF CHILDREN / 1 / THEIR AGES / 16
FAMILY STATUS
SINGLE / SINGLE PARENT / MARRIED /  / SEPARATED / WIDOW
SPOUSE’S NAME / RICKY CARIGMA / OCCUPATION / BRGY ADMIN ASST.
BENEFICIARY / RICK ANDREI CARIGMA / RELATIONSHIP / SON
FATHER’S NAME / ZALDY HALILI / AGE / 54 / OCCUPATION / TRICYCLE DRIVER
MOTHER’S NAME / ANICETA HALILI / AGE / 54 / OCCUPATION / TEACHER
NO. OF BROTHERS / 1 / THEIR AGES / 23 / NO. OF SISTERS / 1 / THEIR AGES / 32
ACADEMIC QUALIFICATIONS
COURSE(s)
COMPLETED / ΟΝΟΜΑ ΤΟΥ ΣΧΟΛΕΙΟΥ/NAME OF SCHOOL / YEAR
FROM / TO
ELEMENTARY / SAN GUILLERMO ELEMENTARY SCHOOL / 1986 / 1993
HIGH SCHOOL / RIZAL POLYTECHNIC COLLEGE / 1993 / 1997
COLLEGE/COURSE
UNIVERCITY/COURSE / COMPUTER PROGRAMMING (STI COLLEGE) / 1997 / 2000
VOCATIONAL / CAREGIVING / 2009 / 2010
OTHERS
ΕΠΑΓΓΕΛΜΑΤΙΚΗΕΜΠΕΙΡΙΑ/WORK EXPERIENCE
(List of all working experience starting from the most recent)
FROM / TO / (1)NAME OF COMPANY/EMPLOYER/
COUNTRY / POSITION / DUTIES&RESPONSIBILITIES
JULY 2016 / APRIL 2017 / YTL AUTODOME SON BHD JW MARRIOTT KUALA LUMPUR / CASHIER WAITRESS / RECEIVING /ASSIST CUSTOMER CASHIER REPORT & SETTLEMENT TAKING ORDER
REMARKS / UNDER AGENT / SALARY / RM 1650
FROM / TO / (2)NAME OF COMPANY/EMPLOYER / POSITION / DUTIES&RESPONSIBILITIES
AUG 2015 / JULY 2016 / LODGE PARADDE HOTEL KUALA LUMPUR / RECEPTIONIST / RESERVATION / RECEPTIONIST DO THE MONTHLY SALES REPORT ATTENDANCE
REMARKS / UNDER AGENT / SALARY / RMDER AGENTES REPORT ATTENDANCEGHE TTLEMENT TAKING ORDERMY BEST SIR. I HOPERE ME. I AM HARDWORKING, TRUSTWORTHY HONEST AND VERY 1500
FROM / TO / (3)NAME OF COMPANY/EMPLOYER / POSITION / DUTIES&RESPONSIBILITIES
AUG 2014 / AUG 2015 / THE ROYALE BINTANG HOTEL KUALA LUMPUR / HOUSEKEEPING ATTENDANT / CLEANING ROOMS/BATHROOMS CHANGING BED LINENS ASSIST GUEST NEED
REMARKS / UNDER AGENT / SALARY / RM 1400
FROM / TO / (4)NAME OF COMPANY/EMPLOYER / POSITION / DUTIES&RESPONSIBILITIES
JUNE 2013 / JAN 2014 / HAIL WA ZAFRAN SWEETS U.A.E. / SUPERVISOR / ALL AROUND WORKER CHECK QUALITY OF PRODUCT CAKE & CHOCOLATE DECORATOR
REMARKS / SALARY
State your priority by numbering from 1 to 10, what you do best, second best, etc.
Cooking / 3 / Baby Care / 7 / Gardening / 2 / Child Care / 6 / Cleaning / 1
Ironing / 5 / Geriatric Care / 8 / Laundry / 4 / Tutoring / 9 / Care of Disabled / 10
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 / 
  1. Are you willing to accept and take your «DAY-OFF’s» set by your employer?
/ YES /  / NO
  1. Are you prepared NOT to use the telephone without permission or consent of your employer?
/ YES /  / NO
  1. Would you be willing and able to follow the all rules and regulations in the house set by your employer?
/ YES /  / NO
  1. Would you promise NOT to invite your friends/relatives in your employer’s residence without their permission/consent?
/ YES /  / NO
  1. Do you smoke? If yes, how many cigarettes per day? ______
/ YES / NO / 
  1. Do you drink? If yes, is it light? ______moderate? ______heavy? ______
/ YES / NO / 
  1. Have you ever experienced taking drugs before? If yes, please specify what kind ______
/ YES / NO / 
  1. Are you under medication? If yes, please specify:______
/ YES / NO / 
  1. Do you have any physical defects/disabilities/sickness? If yes, please specify:______
/ YES / NO / 
  1. Have you suffered from any serious illness before? If yes, please specify: ______
/ YES / NO / 
  1. Have you undergone any operations for the last twelve (12) months? If yes, please specify: ______
/ YES / NO / 
  1. Do you suffer from any forms of allergy? If yes, please specify:______
/ YES / NO / 
  1. Would you be willing and/or able to handle taking care of pets? If yes, please specify: ______
/ YES /  / NO
  1. Can you promise to finish your contract in, say, four (4) years?
/ YES /  / NO
  1. Can you promise to be good to your employer and/or any immediate member(s) of his family?
/ YES /  / NO
  1. Do you promise NOT take any salary advances from your employer, no matter what the circumstances may be?
/ YES /  / NO
  1. Do you promise not to run-away from your employer?
/ YES /  / NO
  1. Can you promise not to go out from your employer’s house without his permission or consent?
/ YES /  / NO
  1. 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 /  / 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?
TO GIVE GOOD FUTURE TO MY SON A TO EARN
b / In your opinion, what are the real qualities of a domestic helper/worker (or caregivers/caretakers)? To your mind, what are these qualities?
OBEDIENT, TRUSTWORTHY, INDUSTRIOUS, HARDWORKING
c / What foreign dish(es)
can you cook? / Chinese / Japanese / Italian / Western / Others
Can you specify or list any of them?
SPAGHETTI, CARBONARA, BURGER,FRIED CHICKEN, FRENCH FRIES
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:
I AM ROSS ANNE CARIGMA. I AM HARDWORING & TRUST WORTHY PERSONM. I WORKED BEFORE AS A HOTEL HOUSEKEEPING ATTENDANT. I WAS TRAINED & STUDY ALSO AS A CAREGIVER.
I AM WILLING TO WORK & DEPLOY FAST AS SOON AS POSSIBLE.

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: / Signature
INTERVIEWR’S REMARKS
NOT FOR SALE

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