外國人確實了解就業服務法相關規定切結書
Waiver: Foreign Workers should fully understand the related regulations of the Employment Service Act (ESA).
本人依中華民國就業服務法相關規定受聘僱來華工作，確實了解以下規定並願加以遵守 I ____________________________ (worker’s name) fully understand and am willing to abide by the following regulations regarding employment in Taiwan in accordance with the ESA.
1、本人入境中華民國後，應接受雇主安排於三日內到中華民國行政院衛生署指定之醫院辦理健康檢 查；往後工作每滿六個月前後三十日期間內，按期接受雇主再安排至指定之醫院接受健康檢查。本 人若拒絕接受健康檢查或健康檢查不合格者，中華民國政府將依法撤銷聘僱許可，並且強制出境 不得再於中華民國境內工作。
After arrival in Taiwan, I must undergo medical examination within 3 days as arranged by the employer in any hospital designated by the central health authorities. I will also undergo medical examination every six months as arranged by the employer in any hospital designated by the central health authorities within thirty days before or after the sixth month period is reached. If I refuse to undergo medical examination, my work permit will be revoked in accordance with R.O.C. regulations and I will be repatriated and cannot re-enter Taiwan for employment.
2、 本人在中華民國境內工作期間，只能為勞動契約上所記載之雇主從事行政院勞工委員會核准之 工作類別。若未經許可為其他雇主工作或從事核准以外之工作，均為違法之行為，中華民國政府將 撤銷聘僱許可，並且強制出境，不得再於中華民國境內工作。
During my employment in Taiwan, I can only engage in work duly approved by the Council of Labor Affairs and work only for the employer specified in the employment contract. If I work for another employer without permission or engage in work not specified in my work permit in violation of the law, my work permit will be revoked by the R.O.C. government and I will be repatriated and can not re-enter Taiwan for employment.
3、 本人在中華民國境內工作期間，不能有連續曠職三日與雇主失去聯繫之行為。若有違反此項規定，
中華民國政府將撤銷聘僱許可，並且強制出境，不得再於中華民國境內工作。
During my employment in Taiwan, I can not be absent without notice and lose contact with my employer for three consecutive days. If I violate this regulation, the R.O.C. government will revoke my work permit and I will be repatriated and can not re-enter Taiwan for employment.
4、 本人在中華民國境內工作期間，親屬不能隨同在中華民國境內居留。若有違反此項規定，中華民 國政府將撤銷聘僱許可，並強制出境，不得再於中華民國境內工作。
During my employment in Taiwan, I can not bring members of my family to reside in Taiwan. If I violate this regulation, my work permit will be revoked by the R.O.C. government and I will be repatriated and can not re-enter Taiwan for employment.
5、 本人不得有竊取或未經雇主同意侵占工作場所內之物品或財物，或故意破壞雇主之所有物品，
或擅自以雇主電話打國際長途或色情電話等違法行為。本人若有上述行為，中華民國政府將追究刑 事責任，並撤銷聘僱許可，於判決確定服刑完畢後，即強制出境，不得再於中華民國境內工作。
I can not steal or use employer’s possessions or articles found in the workplace without permission from the employer. I can not deliberately destroy employer’s possessions or use the employer’s telephone for international or long distance calls or phone sex. If I am guilty of the above-mentioned behavior, the R.O.C. government will pursue a criminal case against me and my work permit will be revoked. After the verdict and sentence has been served, I will immediately be repatriated and can not re-enter Taiwan for employment.
6、 本人在中華民國工作期間，如對雇主、雇主家屬、雇主代理人或其他共同工作之勞工，實施暴行 或有重大侮辱之行為、或違反勞動契約或工作規則，情節重大、故意損害機器、工具、原料、產品或其 他雇主所有物品，或故意洩漏雇主技術上、營業上之祕密，致雇主受有損害者，雇主可以依中華民 國勞動基準法、民法或契約之約定不經預告終止雙方之契約，本人如因上述情形經雇主終止勞動契 約後，中華民國政府將撤銷聘僱許可，並且強制出境，不得再於中華民國境內工作。
During my employment in Taiwan, if I commit violence or extend gross insults at my employer, my employer’s relatives or my employer’s representative, or violate the employment contract or work rules and regulations, or commit grave misconduct, or deliberately destroy equipment/machine, tools, raw materials, products or other articles belonging to the employer, or deliberately leak technical or business secrets, resulting in losses for my employer, the employer can terminate the employment contract without prior notice in accordance with R.O.C.’s Labor Standards Law, Civil Law or the employment contract. If my employment is terminated by the employer due to the above reasons, my work permit will be revoked by the R.O.C. government and I will be repatriated and can not re-enter Taiwan for employment.
7、 本人在中華民國境內工作期間，雇主、雇主家屬、雇主代理人如實施暴行或有重大侮辱之行為，
或契約所訂之工作，對於本人健康有危害之虞，經通知雇主改善而無效果，或雇主不依勞動契約 給付工作報酬，本人可以依中華民國勞動基準法、民法或契約約定不經預告終止契約。本人如因上 述情形與雇主終止契約後，中華民國政府為維護本人權益，得核准由其他雇主接續聘僱。
During my employment in Taiwan, if the employer commits violence or extends gross insults towards me or the specified work in the employment contract endangers my health and shows no improvement despite warnings/notices given to the employer, or the employer does not provide remuneration in accordance with the employment contract, I can terminate the employment contract without prior notice in accordance with R.O.C.’s Labor Standards Law, Civil Law or the employment contract. If I terminate my employment due to the above reasons, in order to protect my rights, the R.O.C. government will approve the transfer to another employer to continue my employment.
8、本人如發現雇主有非法指派本人為其他雇主工作、指派本人從事核准以外之工作或侵害本人之身體、
薪資、財物或其他權益之情形，應立即向中華民國行政院勞工委員會提出檢舉，檢舉專線（英語 ： 0800885885 印尼語：0800885958 泰語：0800885995 越南語：0800017858），或向各 地外籍勞工諮詢服務中心（各諮詢中心服務電話，在中華民國行政院勞工委員會編印之「外籍勞 工在華工作須知」上有詳細記載），或各地警察機關等單位提出檢舉。（上述各單位受理您的檢舉 後，會予以保密及保障您在華之工作權益，不會受到任何損害。）
If I discover that I have been assigned to another employer or other than the approved employment, I must immediately report my situation to the Employment and Vocational Training Administration’s complaint hotline (English: 0800885885; Indonesian: 0800885958; Thai: 0800885995; Vietnamese:
0800017858), or to the Foreign Workers Consultation and Service Centers (telephone numbers of the Centers and other details can be found in the CLA publication entitled “Handbook for Foreign Workers in the Republic of China”), or to police authorities.
立切結書人 Signature of Worker（簽章）：_________________________________________________
英文譯名 Worker’s Name in English：_____________________________________________________
護照號碼 Passport Number：______________________________________________________________
西 元 年 月 日 Date Signed: _________________________________________________
