Website: /
|
|
- Milton Hopkins
- 5 years ago
- Views:
Transcription
1 DANS SERVICES (Filipino Owned Operated Agency ) SINGLE - EX PHILIPPINES MAID (Employment Agency) License No: 04C3439 ORCHARD Orchard Road Lucky Plaza #04-63 S Tel: JURONG 134 Jurong East St 13 #02-309E S Tel: EAST COAST 50 East Coast Rd Roxy Square I # S Tel: IP@CBD 10 Anson Road Int'l Plaza # S Tel: BRIEF DESCRIPTION OF THE APPLICANT 1 Experience maid in the Philippines 2 Can take care of newborn to young children Can cook Filipino dishes and willing to learn more 3 foreign dishes 4 Can performed household chores Website: / Ref No: DANS-PHIL Recommended for : Children / Infant / Cooking / Housework duties / Elderly Care PERSONAL DATA Name : JONNA PACHES LAGUNA Type of Applicant: Domestic Helper (New Maid) Availability : Anytime Date of Birth : September 24, 1987 Marital Status : Single Current Age : 31 Years Old Place of Birth : Norala, South Cotabato No. of Children : 1 Religion : Roman Catholic Ages of Children : 7 to 7 Height: cm. Weight: 63.90kg. Educational Background : College Level Other Education/ Training : Bachelor of Science in Commerce (Undergraduate) Recommended Salary : S$ Preference & Experience Years General Housekeeping 9 Care for Young Children 01 Care for Infant 1 Cooking 9 Care for Elderly and Disabled 0 Preference/Recommendation Other Information Working Experience Home Country 9 Singapore: 0 Malaysia: 0 Hongkong: 0 Taiwan: 0 Middle East: 0 Other Country: 0 Able to care for infant Able to care for elderly Willing to work on Off-days Will extend 2 year contract Can Swim Willing to care for pets English Ability: Other Language: Good Fair Poor English and Filipino DESCRIPTION JONNA PACHES LAGUNA, 29 year old single mother of a 7 year old child from Norala, South Cotabato. She is the 2nd child among her 2 brothers and 2 sisters. Her 51 year old Mother is a housewife while her father is already passed away. She finished her secondary education at Norala National High School graduated 2006, then she enrolled a degree in bachelor of Science in Commerce but did not manage to finish due financial problem. She had her maid employment experience in the Philippines from May Sep / Nov Dec served 2 Filipino families. Currently, she is taking care of her child while waiting to be selected for Singapore. 1) With her 9 years and 7 months of housemaid experience in the Philippines. She is expected to be well-versed in performing general household duties such as maintaining the cleanliness of the house, doing the laundry, pressing clothes, marketing, cooking and washing the dishes. As a mother, she is confident taking care of infant to young children and capable in performing child care duties such as feeding, bathing, preparing their school things, playing with the children, giving assistance for their homework and studies and bringing and fetching them to the school. She is open with the opportunity in looking after elderly person and prepared to be trained in the giving them direct nursing care and supervising their other needs. She knows how to prepare and cook Filipino dishes like sinigang na baboy, adobo, caldereta, aftritada, kare-kare, baked chicken and a lot more. Aside from these duties, she is willing to do basic gardening and car washing as well. This applicant is eager to worked in Singapore to be able to save for her child's education. 2) Philippines (May Sep / Nov Dec. 2015) Initially, she served a Filipino family living in 3 bedroom 2 storey with a couple and 3 children ages 18, 14 and 12 year old. She worked as an all around helper doing houseworks such as maintaining the cleanliness of the house, washing and ironing of clothes, cooking, marketing, washing dishes and other house errands as instructed by her employer and other family members. She served the family for 7 months. On Nov. 2006, she served another Filipino family living in 4 bedroom bungalow with 2 adult and 2 elder ages 64 and 62 year old. She is the 2nd maid. She was an all around housemaid doing all general houseworks sucha as cleaning, doing the laundry and ironing, cooking, marketing, washing dishes and other house errands as instructed by her employer and other family members. She seved the family for 9 years. 3) Upon confirmation to undergo medical and three weeks extensive In-House training in an Accredited Training Center in Mddanila. Then comply with the other POEA requirement for the issuance of OEC prior to deployment to Singapore. Recommended salary to $570.00
2 Other Data ; visit our direct / / To inquire please call : DANS SERVICES Filipino Owned and operated Agency DANS ORCHARD : ( 65 ) DANS JURONG : ( 65 ) DANS EASTCOAST: ( 65 ) Medical History/Dietary Restrictions Allergies (if any): None Past and existing illnesses (including chronic ailments and ilnesses requiring medication): i. Mental Illness ii. Epilepsy iii. Asthma iv. Diabetes v. Hypertension vi. Tuberculosis vii. Heart Disease viii. Malaria ix. Operations Others : Physical disabilities: None Dietary restrictions: None Food handling preferences No pork No beef Others: No food preference. Can handle both pork and beef. Others Name of port / airport to be repatriated to: Manila Contant number in home country: Number of Siblings: 4 Preference for rest day 1-4rest day(s) per month Any other remarks: SKILLS OF FDW Please indicate the method(s) used to evaluate the FDW's skills (can tick more than one): Interviewed by EA: City State Institute and Assesment Center - Interviewed via telephone/teleconference Interviewed via videoconference Interviewed in person Interviewed in person and also made observation of FDW in the areas of work listed in table. S/No Areas of Work 1. Care of Infants/children. Please specify age range: Newborn to young children 2. Care of elderly 3. Care of disabled 4. General housework 5. Cooking. Please specify cuisines: Filipino dishes 6. Language abilities (spoken). Please specify: English and Filipino 7. Other skills, if any. Please specify: Baking and Gardening Willingness Experience Assessment/Observation (Poor to Excellent or N.A) EMPLOYMENT HISTORY OF THE FDW Employment History Overseas EMPLOYMENT HISTORY IN SINGAPORE Previous working experience in Singapore: (The EA is required to obtain the FDW's employment history from MOM and furnish the employer with the employment history of the FDW. The employer may also verify the FDW's employment history in Singapore through WPOL using SingPass). Feedback from previous employers in Singapore
3 AVAILABILITY OF FDW TO BE INTERVIEWED BY PROSPECTIVE EMPLOYER - FDW is not available FDW can be interviewed by phone FDW can be interviewed by video-conference FDW can be interviewed in person OTHER REMARKS Can take care of newborn to young children and elderly. JONNA PACHES LAGUNA / FDW Name and Signature EA Personnel Name and Registration Number Date: May. 13, 2017 Date: May. 13, 2017 I have gone through the 4 page biodata of this FDW and confirm that I would like to employ her / Employer Name and NRIC No. Date: May. 13, 2017 ******************* IMPORTANT NOTES FOR EMPLOYERS WHEN USING THE SERVICES OF AN EA - Do consider asking an FDW who is able to communicate in a language you require, and interview her (in person/phone/videoconference) to ensure that she can communicate adequately. - Do consider requesting for an FDW who has a proven ability to perform the chores you require, for example, performing household chores (especially if she is required to hang laundry from a high-rise unit), cooking and caring for young children or the elderly. - Do work together with the EA to ensure that a suitable FDW is matched to you according to your needs and requirements. - You may wish to pay special attention to your prospective FDW's employment history and feedback from the FDW's previous employer(s) before employing her.
4 BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILE OF FDW A1 Personal Information 1. Name: JONNA PACHES LAGUNA 2. Date of birth: Age: NORALA, SOUTH COTABATO 3. Place of birth: 4. Height & weight: 2 cm kg 4 5. Nationality: FILIPINO 6. Residential address in home country: NORALA, SOUTH COTABATO PHOTO (half/full bodied and coloured) 7. Name of port / airport to be repatriated to: MANILA 8. Contact number in home country: Religion: ROMAN CATHOLIC 10. Education level: HIGH SCHOOL GRADUATE 11. Number of siblings: Marital status: SINGLE 13. Number of children: 1 - Age(s) of children (if any): 7 A2 Medical History/Dietary Restrictions 14. Allergies (if any): NONE 15. Past and existing illnesses (including chronic ailments and illnesses requiring medication): Yes No i. Mental illness vi. Tuberculosis ii. Epilepsy vii. Heart disease iii. Asthma viii. Malaria iv. Diabetes ix. Operations v. Hypertension x. Others: Yes 16. Physical disabilities: NONE 17. Dietary restrictions: NONE 18. Food handling preferences: No pork No beef A-1 Others: No
5
6
7
8
9
10
11
Website: / Availability : Anytime (New Maid)
DANS SERVICES (Filipino Owned Operated Agency ) MARRIED - NEW MAID (Employment Agency) License No: 04C3439 ORCHARD Orchard Road Lucky Plaza #04-63 S238863 Tel: +65 68873944 JURONG 134 Jurong East St 13
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the Biodata as it is an important document to help you select a suitable FDW (A) PROFILE OF FDW Code:
More informationA1 Personal Information Name Dagan Sally Lloren Age 38 Nationality Filipino
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILE OF FDW SUMMARY
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILEOF FDW A1 Personal
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) AMRN1380 *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) A1 PROFILE
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILEOF FDW A1 Personal
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILEOF FDW A1 Personal
More informationMYLENE PARINGIT LACASANDILE (Ref: DANS 20185)
Maid Name MYLENE PARINGIT LACASANDILE Ref. Code Type Rest Day Preference Maid Agency Available Nationality Date of Birth Place of Birth Siblings Height/Weight Religion Marital Status Children Education
More informationBIODATA. *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW
BIODATA AMBW-090#RAYA *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) A1 PROFILE OF FDW (BIO-DATA OF FOREIGN
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILEOF FDW A1 Personal
More informationJENNIFER RAPIZURA (Ref: DANS 20970)
Maid Name JENNIFER RAPIZURA Ref. Code Type Rest Day Preference Maid Agency Available Nationality Date of Birth Place of Birth Siblings Height/Weight Religion Marital Status Children Education Language
More informationA1 Personal Information Name Ani Ruhsotun Bt Sahlan Sadali Age 33 Nationality Indonesian
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILE OF FDW SUMMARY
More information- Age(s) of children (if any): ready passport
PROFILE OF FDW A1 PERSONAL INFORMATIONS 1. Name: DORLIN SUPA 2. Date of birth: 5 OKTOBER 1994 Age: 23 TAHUN 3. Place of birth: POSO 4. Height & weight: 157 CM & 64 KG 5. Nationality: INDONESIAN 6. Residential
More informationAMB-104. PROFILE OF FDW A1 PERSONAL INFORMATIONS 1. Name: CASINIH 2. Date of birth: 9 JUNI 1983 Age: 34 A2 MEDICAL HISTORY/DIETARY RESTRICTIONS
PROFILE OF FDW A1 PERSONAL INFORMATIONS 1. Name: CASINIH 2. Date of birth: 9 JUNI 1983 Age: 34 3. Place of birth: SUBANG 4. Height & weight: 152 CM & 65 KG 5. Nationality: INDONESIAN 6. Residential address
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW)
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important to help you select a suitable FDW (A) A1 PROFILE OF FDW Personal Information
More informationAMRL1497 BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) EX-BRUNEI (A) PROFILE OF FDW. A2 Medical History/Dietary Restrictions
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) AMRL1497 EX-BRUNEI *Please ensure that you run through the information within the Bio data as it is an important document to help you select a suitable FDW (A)
More informationRef GRB 002 AMRLC1606
BIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW. Ref GRB 002 AMRLC1606
More informationBIO-DATA OF FOREIGN DOMESTIC WORKER (FDW) 15. Past and existing illnesses (including chronic ailments and illnesses requiring medication):
BIODATA OF FOREIGN DOMESTIC WORKER (FDW) *Please ensure that you run through the information within the biodata as it is an important document to help you select a suitable FDW (A) PROFILE OF FDW Preference:
More informationPerfect Team Maid Agency Pte Ltd
Name : BANIATUN Code: GMT 586 Age : 42 Country of experience: S PORE/MALAYSIA Marital Status : MARRIED Height/Weight: 150 CM/ 60KG.. MONTHLY SALARY: $550 + $85 (4 OFF DAY COMPENSATE) POCKET MONEY $130
More informationKomela(Excellent) (Ref: LM 004)
Maid Name Komela(Excellent) Ref. Code Type Maid Agency Available Nationality Date of Birth Place of Birth Siblings Height/Weight Religion Marital Status Children Education Language Skill Preference/Aptitude
More informationMargaret (Ref: SLM 173)
Maid Name Margaret Ref. Code Type Maid Agency Available Nationality Date of Birth Place of Birth Siblings Height/Weight Religion Marital Status Children Education Language Skill Preference/Aptitude & Experience
More informationCURRICULUM VITAE PERSONAL DETAILS. Date of Birth: May 18, Able to drive: Willing to learn: Able to swim: Can accept pet s in the house:
CURRICULUM VITAE PERSONAL DETAILS Surname: Given Name: Middle Name: Cabarloc Maribel De Leon Date of Birth: May 18, 1978 Place of Birth: Gender: Nationality: Religion: Height: Father's full name: Mother's
More informationCURRICULUM VITAE PERSONAL DETAILS. Date of Birth: November 22, No. of children: 1. Able to drive: Willing to learn:
CURRICULUM VITAE PERSONAL DETAILS Surname: Given Name: Middle Name: Araja Sherril Condino Date of Birth: November 22, 1982 Place of Birth: Gender: Nationality: Religion: Height: Father's full name: Mother's
More informationSoutheast Asia International Joint-Research and Training Program for Green. Energy Technologies: Biofuel and Renewable Energy Technologies
Southeast Asia International Joint-Research and Training Program for Green Energy Technologies: Biofuel and Renewable Energy Technologies July 8 to July 16, 2016 Organizer: Department of Chemical Engineering
More informationTHE CATHOLIC UNIVERSITY OF EASTERN AFRICA STUDENT S PERSONAL DETAILS FORM
THE CATHOLIC UNIVERSITY OF EASTERN AFRICA A.M.E.C.E.A. P.O Box 62157 00200 Nairobi KENYA Telephone: 0733-900025/0722-509812 Fax: 254-20-891084 Email: registrar@cuea.edu OFFICE OF THE REGISTRAR-ACADEMIC
More informationCHECKLIST. Here s a checklist to help you compile the required documents and items for the submission of admission/ enrolment form.
CHECKLIST Here s a checklist to help you compile the required documents and items for the submission of admission/ enrolment form. 1. Registration Form Complete the registration form. 2. Health Record
More information2018 Application for Scholarship
MID-WEST FASTENER ASSOCIATION P.O. Box 5 Lake Zurich, IL 60047 800.753.8338 p: 847.438.8338 f: 847.438.7580 2018 Application for Scholarship (Application Must Be Typed or Download from mwfa.net) I. Applicant
More informationDOMESTIC PLACEMENT SERVICES
Phone: 772-708-3643 E-Mail: info@dpsag.com Visit Us Online www.dpsag.com DOMESTIC PLACEMENT SERVICES Dear Prospective Job Applicant: Thank you for your interest in placement through DPSAG. We offer a high
More information2016 Child Enrolment Form
Child Outside School Hours Care 2016 Child Enrolment Form Service St Rose Outside School Hours Care 8 Rose Avenue, Collaroy Plateau NSW 2097 Phone: 0407 316 875 Email: collaroy.oshc@dbb.org.au Website:
More informationMaternity and Family Education
2014 Maternity and Family Education Phone: 980-487-3983 email: crmcmaternityandfamilyeducation@carolinashealthcare.org 1 2 Maternity and Family Education Programs When it comes to having a baby, you can
More informationCAGAMAS UNDERGRADUATE SCHOLARSHIP PROGRAMME APPLICATION FORM
CAGAMAS UNDERGRADUATE SCHOLARSHIP PROGRAMME APPLICATION FORM Please read the following instructions carefully before completing the application: 1. Each applicant is allowed to submit ONE application only.
More informationADMISSION INFORMATION CHECKLIST
APPLICANT: ADMISSION INFORMATION CHECKLIST Below is a listing of information needed before scheduling the Pre-Admission Interdisciplinary meeting. NEED: 1. Release of Information 2. Fully Completed Application
More informationPatient Information & Medical History Nurse/Doctor appointment
18 William Street Bellingen NSW 2454 Phone: 6655 0000 Fax: 6655 0266 ABN 35 616 896 074 bhc@bellingenhealingcentre.com.au www.bellingenhealingcentre.com.au Patient Information & Medical History Nurse/Doctor
More informationLove.. Fun..Experience
Enrollment Application Form For KG... Academic Year 20... / 20... Love.. Fun..Experience American Curriculum Application Form Attach 2 Passport Pictures (Please ensure the information provided is accurate
More information: Regional Scout Directors, Council Scout Executives and Officers-In-Charge
Boy Scouts of the Philippines National Office 181 Natividad Almeda-Lopez St. Ermita, 1000 Manila, Philippines E-mail: bsp@scouts.org.ph (632) 528-0555 * (632) 527-5109 * (632) 527-8317 to 20 * Fax (632)
More informationDIOCESE OF BELIZE Prospective Volunteer Profile
DIOCESE OF BELIZE Prospective Volunteer Profile Thank you for your interest in volunteering with our Diocese. Volunteers play a vital role in the furthering our mission. All volunteer applications are
More informationPRIVATIZED HOUSING REFERRAL FORM
PRIVATIZED HOUSING REFERRAL FORM LAST NAME: FIRST NAME: RANK: BRANCH OF SERVICE: GAINING SQUADRON: PHONE: STATUS: Advanced Application Coming from Tech-School Coming from UDR Tour Arrived within 30 days
More informationPERSON CENTRED CARE PLEASE INSERT CURRENT PHOTO HERE NAME: ADDRESS POST CODE: PHONE: MOBILE: Country of origin (birth):
PERSON CENTRED CARE PLEASE INSERT CURRENT PHOTO HERE NAME: DATE OF BIRTH / / MALE FEMALE ADDRESS POST CODE: PHONE: MOBILE: DATE FORM WAS COMPLETED: Country of origin (birth): Language(s) spoken at home:
More informationMaryland JCI Senate Scholarship
Maryland JCI Senate Scholarship Each year the Maryland JCI Senate awards two $500 Scholarships to deserving seniors from Maryland high schools. The Maryland winners are chosen based on merit and need.
More informationDow University of Health Sciences Karachi Department of Postgraduate Studies Baba-e-Urdu Road Karachi PAKISTAN
Dow University of Health Sciences Karachi Department of Postgraduate Studies Baba-e-Urdu Road Karachi PAKISTAN http://www.duhs.edu.pk (TRAINING NAME) ADMISSION FORM Application # (AP No) PHOTOGRAPH Specialty
More informationWelcome to OLGA s Extended Donor Profile
Welcome to OLGA s Extended Donor Profile OLGA voluntarily provided the following information which will be disclosed to future parents as an aid in their selection General Information and characteristics
More informationIntroduction. Consideration for residency is based in part on the following factors:
Introduction Consideration for residency is based in part on the following factors: 1. Ability of the prospective resident to live independently given the availability of supportive services 2. Need of
More informationTIER B OET ONLY PRIVATIZED HOUSING REFERRAL FORM
TIER B OET ONLY PRIVATIZED HOUSING REFERRAL FORM LAST NAME: FIRST NAME: PHONE: EMAIL: PLEASE COME IN PERSON TO HMO FOR VERIFICATION OF ELIGIBLITY BEFORE REFERRAL CAN BE SENT TO SOARING HEIGHTS. STATUS:
More informationMastercard Foundation Scholars Program-KNUST
MCFSP AT KNUST APPLICATION FORM Instructions Mastercard Foundation Scholars Program-KNUST SCHOLARSHIP APPLICATION FORM (/2019) ACADEMIC YEAR 1. Attach a copy of your Senior High School final examination
More informationPERSONAL PORTRAIT. Attach photo here. This document is designed to provide important and relevant information. This Portrait was created on..
PERSONAL PORTRAIT OF.. Attach photo here This document is designed to provide important and relevant information about... This Portrait was created on.. I consent to the information in my Portrait being
More informationADMISSION APPLICATION FORM OF SHELTERED HOMES (Sections A, B and C are to be completed by Referral Agency.)
Date of Referral: Referral Staff Referral Agency Contact/Email/Fax ADMISSION APPLICATION FORM OF SHELTERED HOMES (Sections A, B and C are to be completed by Referral Agency.) GENERAL ADMISSION CRITERIA
More informationNAME SS# ADDRESS CITY STATE ZIP. TELEPHONE (home) (business) Cell SEX M F BIRTH DATE PLACE OFBIRTH RACE ETHNICITY LANGUAGE
REGISTRATION (please print) PATIENT INFORMATION DATE: NAME SS# ADDRESS CITY STATE ZIP TELEPHONE (home) (business) Cell Email SEX M F BIRTH DATE PLACE OFBIRTH RACE ETHNICITY LANGUAGE MOTHER'S FIRST NAME
More informationJCCI SINGAPORE FOUNDATION SCHOLARSHIP TO WASEDA UNIVERSITY ONE-YEAR STUDY PROGRAM 2013/14
JCCI SINGAPORE FOUNDATION SCHOLARSHIP TO WASEDA UNIVERSITY ONE-YEAR STUDY PROGRAM 2013/14 The Japanese Chamber of Commerce & Industry (JCCI) Singapore Foundation, in cooperation with Waseda University
More informationPurpose of recruitment:
Taipei 2017 29th Summer Universiade Volunteer Recruitment Brochure Approved by affairs council of department of human resources of executive committee on Nov. 11, 2015. Purpose of recruitment: 2017 29th
More informationLima and Ayacucho: Understanding Contemporary Peru Program Summer 2010 Acceptance Instructions
Acceptance Instructions Congratulations on your acceptance to Boston University s summer program in Peru! This packet contains information specific to the summer program in Peru. INSTRUCTIONS In addition
More informationApplications for Exchange Starting January 2017
Applications for Exchange Starting January 2017 Initial applications must be submitted to the District 9650 Rotary Youth Exchange Committee. Applications should be lodged with D9650 Youth Exchange Committee
More informationAdditionally, the parent or legal guardian must provide the following documents upon registration of a new student:
Montgomery County Public Schools requires several documents upon registration of a new student. Below is a list of documents which may be downloaded and reviewed and/or completed by the parent or legal
More informationSingle Assessment Process (SAP) Single Assessment Process (SAP) Contact Form. NHS No Agency No
Appendix 1 Single Assessment Process (SAP) Single Assessment Process (SAP) Contact Form Date Title Family Name First Name Preferred Name Gender M F NHS No Agency No DOB Religion Marital status S M W Practising
More informationVacancies Vacancies can be viewed online- follow the Direct Payments link
Vacancies Personal Assistant/Support Worker Ref: 1052 Description: Support required for a 16 year old male, with autism. Hours: 4 hours per week over a few days/evenings, to be discussed at interview.
More informationSAWL SCHOLARSHIP FUND (for students with special needs)
SAWL SCHOLARSHIP FUND (for students with special needs) This Scholarship was founded in memory of The Honourable, the late Mr Justice Tan Ah Tah and was known as "Tan Ah Tah-SAWL Fund". With effect from
More informationHIRING HELP AT HOME. Multiple Sclerosis Basic Facts Series. Accepting the need for help
Multiple Sclerosis Basic Facts Series HIRING HELP AT HOME Accepting the need for help When one member of the family becomes disabled, roles within the family change and it hurts. A person who is used to
More informationOptions for Hiring Household Help Y
Options for Hiring Household Help Y ou contacted our office seeking help in finding a qualified worker to provide household, live-in, companion and/or personal care services. Hiring in-home help is often
More information23 rd World Scout Jamboree Adult Application
SSA Jamboree Office Use Only Date Application Received Jamboree Contingent Number 2 3 W S J A Please use BLACK ink and PRINT in BLOCK CAPITALS & where necessary indicate choice with an Details of Applicant
More informationAPPLICATION FOR EMPLOYMENT
704 Mac Dade Blvd. Collingdale, Pa 19023 Phone: 215-631-3999 Email: hr@caresify.com APPLICATION FOR EMPLOYMENT Caresify is an equal opportunity employer and all applicants will be considered for employment
More informationFeasibility Analysis for Assisted Living A Model for Assessment
Feasibility Analysis for Assisted Living A Model for Assessment Richard Ludtke, PhD Leander McDonald, PhD Alan Allery, PhD National Resource Center on Native American Aging Established in 1994, at the
More informationAPPLICATION FOR TESTING AND SUBSEQUENT CERTIFICATION AS A CERTIFIED NURSE-MIDWIFE (CNM)
APPLICATION FOR TESTING AND SUBSEQUENT CERTIFICATION AS A CERTIFIED NURSE-MIDWIFE (CNM) American Midwifery Certification Board 849 International Drive, Suite 120 Linthicum, MD 21090 410-694-9424 Phone
More informationSacramento County In-Home Supportive Services. Public Authority. Caregiver Registry Application
Sacramento County In-Home Supportive Services Public Authority Caregiver Registry Application This application is for caregivers to be listed on the IHSS Caregiver Registry in order to be referred to IHSS
More informationSoroptimist Women s Opportunity Awards Eligibility Checklist
An international volunteer organization working to improve the lives of women and girls, in local communities and throughout the world. SOROPTIMIST INTERNATIONAL OF THE AMERICAS Soroptimist Women s Opportunity
More informationINDIAN COUNCIL OF SOCIAL SCIENCE RESEARCH
1. Name of the Applicant INDIAN COUNCIL OF SOCIAL SCIENCE RESEARCH 2. Present Position and Institutional Address of the Applicant, if any Application for Post-Doctoral Fellowship Mailing Address of the
More informationCOUNCIL OF INTERNATIONAL PROGRAMS USA
COUNCIL OF INTERNATIONAL PROGRAMS USA 1700 East 13th Street, Suite 4ME Cleveland, Ohio 44114-3213 U.S.A. Telephone: 216.566.1088 Fax: 216.566.1490 E-Mail: info@cipusa.org www.cipusa.org Application For
More informationGUIDELINES FOR SCHOLARSHIP APPLICATION
HEC Needs Based Scholarship Program Page of 8 GUIDELINES FOR SCHOLARSHIP APPLICATION Scholarship is based on assessment of need and merit as well as availability of funds. Selection will be decided on
More informationALWEHDAH BURSARY APPLICATION 2017 (POLYTECHNIC)
ALWEHDAH BURSARY APPLICATION 2017 (POLYTECHNIC) ELIGIBILITY CRITERIA To apply for the Alwehdah Bursary, applicants must fulfill the following eligibility criteria: Applicant must be a Singapore Citizen
More informationChildbirth and Parenting Education Class Schedule for January June 2018
Childbirth and Parenting Education Class Schedule for January June 2018 Whether you re having your first baby or adding to your family, Holy Cross Health is here to help. We offer a variety of classes,
More informationfull family profile PARENT INFORMATION Mother s Name: Work Phone: Father s Name: Work Phone: Occupation: Home Phone:
full family profile The Family Tree provides for both temporary and permanent child and elderly care needs. If your family is in need of only temporary services, please fill out sections 1 through 5, date,
More informationAllergy Consultants, P.A. Visit Date: Specialist in Pediatric and Adult Allergy, Asthma, and Sinus Disease
Allergy Consultants, P.A. Visit Date: Specialist in Pediatric and Adult Allergy, Asthma, and Sinus Disease Arthur Fost, M.D. David Fost, M.D. Satya Narisety, M.D. Anthony J. Piccolo, PA-C Patient s Name
More informationANNEX. Application to attend the. 9 th Course on Women in Port Management Le Havre, France, From 26 June to 07 July 2017
ANNEX Application to attend the 9 th Course on Women in Port Management Le Havre, France, From 26 June to 07 July 2017 Part I Nomination (to be completed by a duly authorized officer of the nominating
More informationWhen. you were a girl... put your dreams on hold? Are you ready to begin yournewlife? did you imagine. a future. filled with hope. and promise?
When you were a girl... did you imagine a future filled with hope and promise? But then your life took an unexpected turn, and you were forced to put your dreams on hold? Are you ready to begin yournewlife?
More informationVersion 21 November 2017 Page 1
Table of Contents About Interim Disability Assistance Programme for the Elderly (IDAPE)...... 3 Am I eligible for IDAPE?... 3 How do I apply for IDAPE?... 4 How do I apply for IDAPE if I am a nursing home
More informationBe part of the company where knowledge, skills and experience can be utilized for the future growth and development.
Arvin S. Cruz Address : Block 29, Lot 16 Lhinette Homes Biga, Tanza, Cavite 4108 Telephone No : +63-46-489-6164 Mobile No : +63-947-953-3142 +63-999-775-1479 E-mail Address : arvin.cruz1979@gmail.com Applied:
More informationOccupational Health Service, Health and Wellness Centre, Ashfield Street London E1 2AH Tel:
Occupational Health Service, Health and Wellness Centre, 31-43 Ashfield Street London E1 2AH Tel: 0207 377 7254 Pre-Course Health Screening Questionnaire For Prospective Students (undergraduates and postgraduates)
More informationPractice Limited to Infants, Children, & Adolescents
Practice Limited to Infants, Children, & Adolescents 9290 SE Sunnybrook Blvd., #200, Clackamas, OR 97015 (503) 659-1694 5050 NE Hoyt St., #B55, Portland, Oregon 97213 (503) 233-5393 16144 SE Happy Valley
More informationCedars HOPE, Inc. RESIDENT APPLICATION
Cedars HOPE, Inc. RESIDENT APPLICATION Agency Name: Agency address: REFERRING AGECNY INFORMATION Fax: Referring Person Name: Contact Email Date of Referral: / / Name: APPLICANT INFORMATION Date of birth:
More information2018 CAMS Scholarship Application Instructions
2018 CAMS Scholarship Application Instructions DEADLINE The deadline to submit your application and all supplemental materials is March 31, 2018 11:59 PM EST. ELIGIBILITY The scholarship is open to all
More information2017 CRCA Scholarship Awards Program
CHICAGO ROOFING CONTRACTORS ASSOCIATION 4415 W. Harrison St. Suite 540 Hillside, Illinois 60162 2017 CRCA Scholarship Awards Program The Chicago Roofing Contractors Association (CRCA) will grant two $4,000
More informationII. How strictly I want my agent to follow my instructions:
MY HEALTH CARE CHOICES (OPTIONAL SUPPLEMENT) 1 of 4 Personal Health Care Instructions Communication Form Name: Kaiser MRN#: I. How much I want to know about my condition: (Please mark statement 1 or 2.)
More informationTuition (Associate-level) $6, $6, $13,500.00
Selection Procedures for NIFT Students for One Year Associate in Applied Science (AAS) Program at Fashion Institute of Technology (FIT), New York ACADEMIC YEAR 2018-19 Program Eligible The students of
More informationLingnan University Office of Global Education Application for Student Exchange Programme User Guides for Applicants
Lingnan University Office of Global Education Application for Student Exchange Programme User Guides for Applicants PART A IMPORTANT NOTES FOR APPLICANT... 2 PART B TENTATIVE SCHEDULE FOR SPRING 2019 SEMESTER...
More informationMaster in Anti-Corruption Studies 2018 Programme
Ref. No.: IACA-2017-MACS-0001-212 Master in Anti-Corruption Studies 2018 Programme GUIDELINES FOR THE APPLICATION PROCEDURE Admission Criteria Admission to the Master of Arts in Anti-Corruption Studies
More informationCenter House Nashville Application
Center House Nashville Application Our goal is to provide a structured living environment, promoting spiritual growth through the teachings of Jesus Christ, fellowship and accountability. Mission Statement:
More information2018 CISCO SCHOLARSHIP AWARD PROGRAM FOR HIGH SCHOOL SENIORS
2018 CISCO SCHOLARSHIP AWARD PROGRAM FOR HIGH SCHOOL SENIORS OBJECTIVE: To provide financial support to college-bound children of building trade union members and employees of union contractors. Three
More informationCREW ASIA IS THE LEADING PROVIDER OF THE FINEST CREW TO THE MEGA YACHT INDUSTRY THROUGH COMPETENT AND EXCELLENT SERVICE DECK APPLICATION FORM
Position Applied: PERSONAL INFORMATION: DECK APPLICATION FORM Date: Last Name: First Name: Middle Name: Address: Skype Name: Email: Religion: Height: (cm/ft/in) Weight: (lbs/kg) Contact #: Gender: Civil
More informationResidential Nursing Home & Neighbourhood Care Centre
The Lawns Residential Nursing Home & Neighbourhood Care Centre The Lawns was built in the 1770 s and remains a pleasant family house situated in half an acre of attractively landscaped gardens on the outskirts
More informationAPPLICATION FORM FOR REGULAR VOLUNTEERS
Thank you for choosing to volunteer at KK Women s and Children s Hospital! Kindly provide us with your details below and we will be in contact with you soon. Please note: Please fill in ALL sections. The
More informationRULE 203 FAMILY Adult Foster Care With a 245D-HCBS Program License Licensing Checklist
RULE 203 FAMILY Adult Foster Care With a 245D-HCBS Program License Licensing Checklist License Holder s Name: AFC License #: Program Address: Date of review: (indicate type) Initial Renewal Other C = Compliance
More informationReminders for you as you come in for your first appointment
Reminders for you as you come in for your first appointment * Please complete this paperwork and bring it to your first appointment If you are unable to complete this paperwork prior to your appointment,
More informationAdditional Support Services
Additional Support Services The following services are not directly offered by ElderSource. However, our Customer Service Specialists will be pleased to talk with you, assess your specific needs and connect
More informationPLEASE WRITE YOUR DETAILS IN CLEAR BLOCK CAPITALS / / Address: Partnership status: Single Separated Divorced Married Co-habiting Widowed
Welcome to The Old Dairy Health Centre As it can take several weeks before we receive your medical records please respond to the following questionnaire. PLEASE WRITE YOUR DETAILS IN CLEAR BLOCK CAPITALS
More informationDRUG / MEDICATION ALLERGIES: (include: Type/Reaction)
NASSAU CHEST PHYSICIANS PC MEDICAL QUESTIONNAIRE 1 DATE: PATIENT NAME: DOB: DRUG / MEDICATION ALLERGIES: (include: Type/Reaction) 9/1/2014 PHARMACY NAME PHARMACY PHONE PHARMACY Street Address City State
More informationFOURTH DEGREE PRO DEO AND PRO PATRIA SCHOLARSHIPS FOR COLUMBIAN SQUIRES FOR THE ACADEMIC YEAR BEGINNING SEPTEMBER 2019
KNIGHTS OF COLUMBUS Making a Difference for Life TO: FROM: RE: SCHOLARSHIP APPLICANT DEPARTMENT OF SCHOLARSHIPS FOURTH DEGREE PRO DEO AND PRO PATRIA SCHOLARSHIPS FOR COLUMBIAN SQUIRES FOR THE ACADEMIC
More information2017 Consumer In-Home Services Assessment Form Updated 7/12/2017
OFFICE USE Rec d: Assessment Date: Start Date: GRAY GOURMET Harmony # Route # 2017 Consumer In-Home Services Assessment Form Updated 7/12/2017 Basic Client Information Date of Assessment: / / First Name:
More informationST. LAWRENCE REHABILITATION CENTER OUTPATIENT POLICIES AND REGISTRATION INFORMATION
Outpatient Services 2381 Lawrenceville Road 609-896-9500 voice Patient Name: Account #: ST. LAWRENCE REHABILITATION CENTER OUTPATIENT POLICIES AND REGISTRATION INFORMATION Your first day of outpatient
More informationThe Wellmet Project Incorporated 675 Massachusetts Avenue Cambridge, MA Phone: (617) Fax: (617) APPLICATION
The Wellmet Project Incorporated 675 Massachusetts Avenue Cambridge, MA 02139 Phone: (617) 491-2377 Fax: (617) 491-3195 APPLICATION SECTION 1 -- TO BE FILLED OUT BY REFERRING SOURCE: SOCIAL WORKER, THERAPIST,
More informationOHIO JCI SENATE CHARITABLE AND EDUCATION FOUNDATION
OHIO JCI SENATE CHARITABLE AND EDUCATION FOUNDATION October 2009 Attached is the application for the U.S. JCI Senate Foundation scholarship program. The U.S. JCI Senate is made up of the life members of
More informationCumbrae House Care Home Service Adults 4-18 Burnbank Terrace Glasgow G20 6UQ Telephone:
Cumbrae House Care Home Service Adults 4-18 Burnbank Terrace Glasgow G20 6UQ Telephone: 0141 332 5909 Inspected by: Alison McEleny Type of inspection: Unannounced Inspection completed on: 20 September
More informationExtended Day Registration Packet
St. Benedicts School Extended Day Registration Packet 2014 2015 School Year 4811 Wallingford Avenue North Seattle, Washington 98103 206-518.6009 l.wescott@stbens.net A Registration Packet Contents The
More information