| A1 Personal Information | |||
| 姓名 Name |
SRINI |  |
|
| 生日 Date of Birth |
14-May-1982 | ||
| 年齡 Age |
42 | ||
| 工作經驗 Years of Experience |
5 | ||
| 出生地點 Place of Birth |
INDRAMAYU | ||
| 护照 Passport No. |
护照日期 Passport Date |
- | |
| 身高 Height |
150 cm | 體重 Weight |
49 kg |
| 國籍 Nationality |
INDONESIA | 宗教 Religion |
MOESLIM |
| 教育程度 Education level |
JUNIOR HIGH SCHOOL | 婚姻狀況 Marital Status |
MARRIED |
| 电话号码 Contact No. |
+6283134687721 | 孩子年龄 Child's Age |
9 YRS (GIRL) |
| 兄弟姐妹人數 Number of Siblings |
1 BROTHER, 3 SISTERS | 子女人數 Number of children |
1 |
| 父親姓名 Father's name | SUTA | 父親年齡 Father's age | 65 |
| 母親姓名 Mother's name | KURSINAH | 母親年齡 Mother's age | 64 |
| 配偶姓名 Spouse's name | MARSA | 配偶年齡 Spouse's age | 50 |
| 受益人 Beneficiary | 怕不怕狗 Afraid of dogs? | No | |
| 可以吃豬肉 Can eat pork? | 可抱 Can lift(Kg) | ||
| 願意幫阿公洗澡 Willing to help elderly bathe? | |||
| A2 Medical History/Dietary/Restrictions | |
| 过敏（如果有） Allergies (if any) |
|
| Past and existing illness (including chronic ailments and illnesses requiring medication) | |
| Mentall illness | No |
| Tuberculosis | No |
| Epilepsy | No |
| Heart disease | No |
| Asthma | No |
| Malaria | No |
| Diabetes | No |
| Operation | No |
| Hypertension | No |
| Physical disability | |
| Dietary restrictions | |
| A3 Other | |
| Food handling preferences | |
| Preference for rest day | |
| Remarks | LANGUAGE: BAHASA MALAYSIA |
| B1 Method of Evalution of Skills | ||
| Areas of Work | Yes/No | |
| 復健 Rehabilitation | ||
| 喂食/洗澡 Feeding/bathing | ||
| 抽痰 Suctioning | ||
| 打針 Injection | ||
| 按摩/陪伴病人 Massage/accompanying patients | ||
| 替病人處理大小便 Treating patients' urination and defecation | ||
| 做月子 Confinement | ||
| 換尿布 Changing diapers | ||
| 洗澡 Bathing | ||
| 陪伴游戲 Playing games with children | ||
| 照顾婴儿 Baby care | Willing | |
| 照顾小孩 Child care | Yes | |
| 照顾老人 Elderly care | Yes | |
| 卧床不起 Bedridden care | No Experience | |
| 打扫家里 Housekeeping | Yes | |
| 煮饭 Cooking | Yes | |
| (C) EMPLOYMENT HISTORY OF FDW | ||||||
| Date | Country | Employment | Work Duties | Remarks | ||
| From | To | |||||
| MIDDLE EAST | Housemaid in Arab (2009-2014) | Take care of children 3 and 2 yrs old, do general housework. Washing clothes, ironing and cooking | Finish | |||
| (D) AVAILABILITY OF FDW TO BE INTERVIEWED BY PROSPECTIVE EMPLOYER | ||||||
| FDW can be interviewed by phone | ||||||
| FDW can be interviewed by video-conference | ||||||