Ref No: OS LYCA Type: 1ST TIMER

Expiration of Visa: Last date with last employer:

Personal Particular
Name:	LYCA	Birth date:	2000 / 龍 / 天秤座
Age:	24	Civil status:	Single Parent
Height:	4'9 inch	Weight:	45 kg
Religion:	Catholic	Language Spoken:	English
Philippine Address:	BRGY VILLACONSUELO NAVAL BILIRAN
Family Background
Name of spouse:	N/A	His/Her Occupation:	N/A
No of children:	2	Ages of children & Gender:	2 (Boy), 5 (Boy)
Age of mother:	46	Ages of father:	47
Your number in family:	2
No of Brothers you have:	0	No of Sisters you have:	3
Educational Attainment
High School Year 2020

My Special Skills and Experience
Domestic work	Experience	Special Skill
Newly born Care			Age: 1moth
Child Care			Age: 5
Care of Special Child/Person			Age:
Care of Disabled Child/Person			Age:
Elderly Care (60 and above)			Age:
Child Tutoring
Cooking			Chinese      Western
Pet

Employment Record
1.	Name of Employer:	JESSICA			Duration:	2020-01-01 - 2022-01-01			Country-Area:	PAMPANGGA
	Nationality:	PHILIPPINES			No of Family Members:	4			No of years served:	2
	No of Adult (18+):	2			No of elderly (65+):		Ages:
	No of Kids (0-17):	2	Ages:	2 AND 5	No of maids:	1			Size of house/flat:
	Reason of leaving:	I'M GO HOME IN PROVINCE
	Duties:	Taking care children cooking cleaning washing clothes Ang ironing
	Remark:
2.	Name of Employer:				Duration:	-			Country-Area:
	Nationality:				No of Family Members:				No of years served:
	No of Adult (18+):				No of elderly (65+):		Ages:
	No of Kids (0-17):		Ages:		No of maids:				Size of house/flat:
	Reason of leaving:
	Duties:
	Remark:

Employment Record
3.	Name of Employer:				Duration:	-			Country-Area:
	Nationality:				No of Family Members:				No of years served:
	No of Adult (18+):				No of elderly (65+):		Ages:
	No of Kids (0-17):		Ages:		No of maids:				Size of house/flat:
	Reason of leaving:
	Duties:
	Remark:

Questionnaire	Y是/N否
1. Are you willing to accept a weekday off or any day to be assigned by your employer?
2. Are you prepared to return home at a time set by your employer during your day off?
3. Can you promise not to ask salary in advance?
4. Are you willing to cut your hair short if your employer require?
5. Are you willing to take care and sleep with baby/children at night?
6. Are you willing to work with a stay-in employer?
7. Are you willing to work with another helper?
8. Can you promise not to use telephone without the permission of your employer?
9. Have you suffered from any serious illness? If yes, specify:
10. Can you drive vehicle?
11. Are you afraid of dog? Other pets?
12. Are you willing to follow the code of discipline drawn by your agency?
13. Do you smoke or drink (alcohol)?
14. Have you ever worked in Hong Kong as a domestic helper? if Yes, please declare in the Work History section.
15. Do you have Tattoos on your body? If yes, please specify.

Personal Declaration:
I hereby certify that the above information is true and correct to the best of my knowledge and belief. I understand any false information may result to my future termination of my employment due to dishonesty.