Description
Health and Preferences Information
| Question | Answer |
|---|---|
| Allergies (if any) | – |
| Past and existing illnesses (including chronic ailments and illnesses requiring medication) | |
| i. Mental illness | NO |
| ii. Epilepsy | NO |
| iii. Asthma | NO |
| iv. Diabetes | NO |
| v. Hypertension | NO |
| vi. Tuberculosis | NO |
| vii. Heart disease | NO |
| viii. Malaria | NO |
| ix. Operations | NO |
| Others | – |
| Physical disabilities | NO |
| Dietary restrictions | NO |
| Food handling preferences | NO RESTRICTION |
| Preference for rest day | 1-2 rest day (s) per month |
| Any other remarks | – |
Areas of Work
| Areas of Work | Willingness Yes /No |
Experience Yes/No if yes, state the no. of years |
Assessment / Observation Please state qualitative observation of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor………………..Excellent…N.A 1 2 3 4 5 N.A |
|---|---|---|---|
| Care of infants / children | YES | NO | 3 |
| Care of elderly | YES | NO | 3 |
| Care of disabled | NO | NO | 2 |
| General housework | YES | YES | 3 |
| Cooking
Please specify cuisines: |
YES | YES | 3 |
| Language abilities (spoken) | YES | 3 | |
| Other skills, if any |
Employment History Overseas
| Date | Country (including FDW’s home) |
Employer | Work Duties | Remarks | |
|---|---|---|---|---|---|
| From | To | ||||