AF-T14 1110701 版
外國人同意轉換雇主或工作證明書(中英雙語版)
Transferring employer or work certificate for foreign worker
雇主名稱
Employer’s name
統一編號或身分證字號
Employer’s register No. or ID No. 聯絡電話
Contact No.
外國人姓名
Foreign worker’s name 護照號碼
Passport No.
雇主有下列情事之ㄧ（請擇一勾選），本人（外國人）同意轉換雇主或工作，並願依相關規定辦理：
In case that employer has the following situation (please choose one), I am willing to transfer to a new employer or work in accordance with related regulations.
1. 被看護者 Original patient □a.死亡 dies□b.移民 emigrates.（不可申請遞補招募許可）(It is not allowed to apply for recurrence letter of recruitment) .
2. 原雇主 Original employer □a.死亡 dies□b.移民 emigrates..（不可申請遞補招募許可）(It is not allowed to apply for recurrence letter of recruitment) .
3. □船舶被扣押、沉沒或修繕而無法繼續作業者。（不可申請遞補招募許可）
The vessel he/she works on has been detained, sunk, or under repaired, leading to the discontinuation of the work. (It is not allowed to apply for recurrence letter of recruitment).
4. □雇主關廠、歇業或不依勞動契約給付工作報酬經終止勞動契約者。（不可申請遞補招募許可）
The original employer winds up the factory, suspends the business, or fails to pay the salay in accordance with the employment contract, leading to the termination of the labor contract. (It is not allowed to apply for recurrence letter of recruitment).
5. □其他不可歸責於受聘僱外國人之事由者。
（不可申請遞補招募許可）(It is not allowed to apply for recurrence letter of recruitment).
Other circumstances are not attributable to the employed foreigner.
6. □家庭外籍看護工經雇主同意轉換雇主或工作。（可申請遞補招募許可，但中階技術工作者除外）
Except for intermediate-technicians, through the agreement of the employer, domestic helpers are allowed to change employers or jobs.
7. □雇主與外國人協議期滿不續聘：（不可申請遞補招募許可）
Employer and foreigners agree not to renew the employment when the contract expires. (It is not allowed to apply for recurrence letter of recruitment).
外國人希望工作區域 (請填寫縣市)外國人行動電話 Foreigners desire to work areas (Please fill in cities and counties)
Contact telephone number of foreigner
若未填寫希望工作區域，則以目前外國人工作地址之縣市登錄至外國人轉換雇主網路作業系統。
If you don’t fill in the desired work area, the address on the system of foreign worker transfer employer will be the current work address.
備註：勾選第 6 項外國人轉換理由，雇主可依就業服務法第 58 條第 2 項第 3 款規定向本部申請遞補 招募許可，但中階技術工作者除外。
Notice: If the you choose the number 6, the employer may apply for recurrence letter of recruitment from the Ministry of Labor according to paragraph 3, Section 2, Article of 58 the Employment Services Act. (Not applicable to intermediate-technicians).
廢止聘僱許可申請 Applying for the revocation of the approval of the employment permit
1.□聘僱關係自 年 月 日起終止（自聘僱關係終止日起廢止聘僱許可，外國人於等待轉換 雇主期間不得從事工作）Employment relationship has been terminated since Year Month Day (Abolished the employment permit from the date of the employment relationship, while waiting for transferring to a new employer, the foreigner shall not engage in work.)
2.□依規定無法出席協調會、無法轉換雇主或工作之翌日起終止聘僱關係（外國人於等待轉換雇主期 間仍得從事工作）In accordance with rules if the employed foreigner does not attend council, they cannot transfer a new employer or jobs, the employment relationship must terminate from now on. (The foreigner shall engage in work while waiting for transferring to a new employer.)
3.□雇主與外國人協議期滿不續聘，聘僱關係自原聘僱期滿日終止。
Employer and foreigners agree not renew the employment when the contract expires. The date of contract end is the original employment date.
備註：1.除期滿不續聘應勾選第 3 點以外，本欄務必依實際需要勾選，未勾選者，視同自無法轉換雇 主或工作之翌日起終止聘僱關係。
2.若勾選聘僱關係已終止，未填寫聘僱關係終止日，則以交郵或親送日（即申請日）為聘僱關 係終止日期。
AF-T14 1110701 版 3.受聘僱之外國人有聘僱關係終止之情事，依就業服務法第 56 條規定，雇主應於 3 日內以書
面通知當地主管機關、入出國管理機關及警察機關，若有違反，依同法第 68 條規定處新臺 幣 3 萬元以上 15 萬元以下罰鍰。
Notice:
1. Except for discontinuation of employment, please choose the number 3. You must choose one of the above items according to actual needs; otherwise, the employment relationship will be terminated from the day following the inability to change employers or jobs.
2. If you select to terminate the employment relationship, but do not provide the termination date, it will be regarded as the date of delivery by post or submitting in person (i.e. the date of filling application).
3. According to Article 56 of the Employment Service Act, the employment shall notify the local competent authority in writing within 3 days if the employment relationship of employed foreigners is terminated. According to Article 68 of the Employment Service Act, those who violate shall be fined an amount of at least NT$ 30,000 and not more than NT$ 150,000.
雇主 Employer： （簽章 Signature）
外國人 Foreigner： （簽章 Signature）
