Provisional Employers Registration Form
Name of Employer
(As In Passport or NRIC)
NRIC No
-
-
OR
Passport No
Income Tax Number
Nationality
Age
-
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
Race
Residential Address
Company Name
Business Address
E-mail Address
Office Telephone No
House Telephone No
Handphone No
Occupation
Religion
Income
Per Month Currency
MYR
SGD
AUD
USD
EURO
Others
Others
SPOUSE DETAILS
Name of Spouse
(As In Passport or NRIC)
NRIC No
-
-
Passport No
Income Tax Number
Nationality
Choose one
Malaysia
Indonesia
Filipino
Cambodia
Singapore
Sri Lanka
India
Pakistan
Age
-
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
Race
Company Name
Business Address
E-mail Address
Handphone No
Office Telephone No
Occupation
Religion
Income
Per Month Currency
MYR
SGD
AUD
USD
EURO
Others
Others
FAMILY DETAILS
No of Family Members
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
No of Babies below 12 months
0
1
2
No. Of Children
0
1
2
3
4
5
6
7
8
9
10
No of Males
0
1
2
3
4
5
6
7
8
9
10
No of Females
0
1
2
3
4
5
6
7
8
9
10
Age From
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
to
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
No. Of Elders
0
1
2
3
4
5
6
7
8
9
10
Age From
-
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
Years to
-
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
Live in Handicapped / Invalid Persons
0
1
2
3
4
5
6
7
8
9
10
Languages Spoken
Type Of House
Choose One
Apartment
Condominium
Single Storied Terrace
Double Storied Terrace
Single Storied Bungalow
Double Storied Bungalow
Semi Detached Bungalow
No of Rooms
0
1
2
3
4
5
6
7
8
9
10
No of Toilets
0
1
2
3
4
5
6
7
8
9
10
No of Cars
0
1
2
3
4
5
6
7
8
9
10
Monthly Salary Offered to Housemaid
Weekly restday allowed
0
1
2
3
4
Other Working Conditions
Is your family Vegetarian or Non-Vegetarian?
Vegetarian
Non-Vegetarian
Record of Housemaids employed by you to-date?
Nationality
Year From
Year To
Status
Completed Contract
Runaway
Medically Unfit
Not Compatible
Homesick
Others
Completed Contract
Runaway
Medically Unfit
Not Compatible
Homesick
Others
Completed Contract
Runaway
Medically Unfit
Not Compatible
Homesick
Others
Completed Contract
Runaway
Medically Unfit
Not Compatible
Homesick
Others
Completed Contract
Runaway
Medically Unfit
Not Compatible
Homesick
Others
STATE THE TYPE OF WORK YOU REQUIRE THE HOUSEMAID TO DO
Laundry and Ironing
Care of Children
Cooking
Care of Invalids
Mopping/ Vacuum Cleaning
Gardening
Baby Sitting
General Housework
Wash Car
Care of Dogs
Care of Cats
Care of Other Pets
I have been recommended to
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