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Details - Ni Wayan Suryani  
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Ref. Num: WS

(A) PROFILE OF FDW

A1 Personal Information

 
1. Name :
Ni Wayan Suryani
2. Date of Birth :
29/5/1977     Age: 45 yrs
3. Place of Birth :
Surabaya
4. Height & Weight :
164 cm 60 kg
5. Nationality :
Indonesian
6. Residential address in home country :
Lampung Tenga Surabaya
7. Name of port/airport to be repatriated to :
Surabaya
8. Contact number in home country :
9. Religion :
Muslim
10. Education level :
Junior High School
11. Number of siblings :
5
- Position among the siblings (if any) :
12. Marital status :
Single
13. Number of children :
0
- Age(s) of children (if any) :
 
A2 Medical History/Dietary Restrictions
 
14. Allergies (if any) :
15. Past and existing illnesses (including chronic ailments and illnesses requiring medication):

  Yes No   Yes No
i. Mental illness vi. Tuberculosis
ii. Epilepsy vii. Heart disease
iii. Asthma viii. Malaria
iv. Diabetes ix. Operations
v. Hypertension x. Others: N.A

16. Physical disabilities :
17. Dietary restrictions :
18. Food handling preferences: No Pork  No Beef   Others:
 
A3 Others
 
19. Preference for rest day :
rest day(s) per month.
20. Any other remarks :

(B) SKILLS OF FDW

B1 Method of Evaluation of Skills

Please indicate the method(s) used to evaluate the FDW's skills (can tick more than one):
Based on FDW's declaration, no evaluation/observation by Singapore EA or overseas training centre/EA
Interviewed by Singapore EA
  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 Willingness
Yes/No
Experience
Yes/No
If yes, state the no. of years
Assessment/Observation
Please state qualitative observations 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
1 Care of infants/children


Please specify age range:
Yes Yes, 0 year(s) Good

2 Care of elderly Yes Yes, 2 year(s) Good

3 Care of disabled Yes Yes, 2 year(s) Good

4 General housework Yes Yes, 5 year(s) Excellent

5 Cooking


Please specify cuisines:
Yes Yes, 5 year(s) Good

6 Language abilities (spoken)


Please specify:
Bahasa, English
Yes, 0 year(s) Good

7 Other skills, if any


Please specify:
Yes Yes, 0 year(s)


Interviewed by overseas training centre / EA (Please state name of foreign training centre / EA:

   State if the third party is certified (e.g. ISO9001) or audited periodically by the EA:
  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 Willingness
Yes/No
Experience
Yes/No
If yes, state the no. of years
Assessment/Observation
Please state qualitative observations 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
1 Care of infants/children


Please specify age range:
Yes Yes, 0 year(s)

2 Care of elderly Yes Yes, 0 year(s)

3 Care of disabled Yes Yes, 0 year(s).

4 General housework Yes Yes, 0 year(s)

5 Cooking


Please specify cuisines:
Yes Yes, 0 year(s)

6 Language abilities (spoken)


Please specify:
Yes, 0 year(s)

7 Other skills, if any


Please specify:
Yes Yes, 0 year(s)


(C) EMPLOYMENT HISTORY OF THE FDW

C1 Employment History Overseas

Date Country (including FDW's home country) Employer Work Duties Remarks
From To
Sep 2013 Sep 2015 Singapore Chinese/Indonesia Presently working for Chinese/Indonesian family HDB 4 room 3 children ages 15, 11, 10
May 2012 Aug 2013 Singapore Chinese family She worked for Chinese family in a 2 level HDB (Mansionette) 2 children ages 19, 17 1 small dog
Apr 2010 Apr 2012 Singapore Chinese/Indian She workef for Chines/Indian family in a 2 storey house 67 years old grandma (Dementia Patient)
Jan 2010 April 2010 Singapore Chinese family She worked for Chinese family in a 3 storey house 2 grown up children
 
C2 Employment History in Singapore
Previous working experience in Singapore:   Yes   No
(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)
 
C3 Feedback from previous employers in Singapore
Feedback was/was not obtained by the EA from the previous employers. If feedback was obtained (attach testimonial if possible), please indicate the feedback in the table below:

  Feedback
Employer 1
Employer 2

(D) AVAILABILITY OF FDW TO BE INTERVIEWED BY PROSPECTIVE EMPLOYER
FDW is not available for interview
FDW can be interviewed by phone
FDW can be interviewed by video-conference
FDW can be interviewed in person

(E) OTHER REMARKS
COntact Joy at 6463 0990 Email: joyseah.ajsmanpower@gmail.com
 
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