| A1 Personal Information | |||
| 姓名 Name |
DIAN SANDHIKA |  |
|
| 生日 Date of Birth |
13-Jun-1991 | ||
| 年齡 Age |
33 | ||
| 工作經驗 Years of Experience |
1 | ||
| 出生地點 Place of Birth |
SUKABUMI | ||
| 护照 Passport No. |
护照日期 Passport Date |
- | |
| 身高 Height |
162 cm | 體重 Weight |
82 kg |
| 國籍 Nationality |
INDONESIA | 宗教 Religion |
MOESLIM |
| 教育程度 Education level |
SMP | 婚姻狀況 Marital Status |
MARRIED |
| 电话号码 Contact No. |
083845408119 | 孩子年龄 Child's Age |
11 YRS, 8 YRS, 5 YRS |
| 兄弟姐妹人數 Number of Siblings |
1 BROTHER | 子女人數 Number of children |
3 |
| 父親姓名 Father's name | ENDANG HERYANA | 父親年齡 Father's age | 60 |
| 母親姓名 Mother's name | TATI | 母親年齡 Mother's age | 55 |
| 配偶姓名 Spouse's name | DIKI SUSANTO | 配偶年齡 Spouse's age | 36 |
| 受益人 Beneficiary | 怕不怕狗 Afraid of dogs? | Yes | |
| 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 | |
| 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 | Yes | |
| 照顾小孩 Child care | Yes | |
| 照顾老人 Elderly care | Yes | |
| 卧床不起 Bedridden care | ||
| 打扫家里 Housekeeping | Yes | |
| 煮饭 Cooking | Yes | |
| (C) EMPLOYMENT HISTORY OF FDW | ||||||
| Date | Country | Employment | Work Duties | Remarks | ||
| From | To | |||||
| SINGAPORE | Housemaid [2022-2023] | Take care of grandma 68 yrs old. Do general housework, wash the clothes, ironing and cooking | grandma passaway | |||
| (D) AVAILABILITY OF FDW TO BE INTERVIEWED BY PROSPECTIVE EMPLOYER | ||||||
| FDW can be interviewed by phone | ||||||
| FDW can be interviewed by video-conference | ||||||