雇 主 聘 僱 外 國 人 申 請 書（外國人代雇主申請，中英文版）
APPLICATION FORM FOR EMPLOYMENT OF FOREIGNERS (For foreigner to apply on behalf of the employer)
工作類別：
category
5.海洋漁撈工作 Ocean fishing
□漁業人（自然人）
fishery operator (a natural person)
□漁業公司（法人）
fishery operator (a legal person)
□箱網養殖（自然人）
cage culture (a natural person)
□箱網養殖（法人）
cage culture (a legal person)
申請項目： 接續聘僱許可
Applying Item: consecutive employment permit
□62 至公立就業服務機構接續
to a public employment service institution
□63 三方合意 three-party consent
□63 雙方合意 two-party consent
限外國人原聘期屆滿，因疫情影響未能出國且雇主未辦理期滿續聘或 期滿轉換
The original employment period of the foreigner has expired, but the foreigner cannot go abroad due to the pandemic and the employer has not applied for renewal of employment or transferring.
□62 至公立就業服務機構接續 to a public employment service institution
□63 雙方合意
two-party consent to consecutive employment 外國人填寫欄位
Foreigner information
國籍 Nationality
護照號碼 (填表說明注意事項
二) Passport Number
(see notice 2)
外國人行動電話 (必填，填表說明注意事項三)
Mobile number (required, see notice 3)
外國人電子郵件 (填表說明注意事項三)
E-mail (see notice 3) 菲律賓
The Philippines
□有 Yes:
□無 No
本申請案回復方式：□親取 □郵寄外國人工作地址 (請擇一勾選)
I would like □ to pick up the official document or □ to have the official document deliver to Foreigner’s work address.(Tick one of the boxes above)
本人聲明本申請案所填寫資料及檢附文件等均屬實，如有虛偽，願負法律上之一切責任。
I hereby declare the information and documents provided to be true, and confirm with full legal responsibility for any perjuries found.
外國人簽名：
Foreigner’s signature:
雇主協助外國人填寫欄位 Application information 漁船(箱網養殖)
名 稱
Name of the boat (cage culture)
漁船統一編號 CT number
雇主姓名
(有附許可函則免填) Name of the employer (not required if the permit is attached)
雇主身份證字號 (有附許可函則免填) Employer’s ID number (not required if the permit is attached) 請
詳 閱 背 面 填 表 說 in the back 明ce on the back noti
審查費收據
(有附則免填，填表說明 注意事項五)
Receipt of application fee (see notice 5)
繳費日期
Date 年 月 日
y/ m/ /d
郵局局號(6 碼) Branch code (6 digits) 劃撥收據號碼(8 碼)或交易序號(9 碼)
Receipt No. (8 digits) or transaction No. (9 digits)
原雇主名稱
Name of the original employer
原雇主統一編號 Tax ID number of the original employer
當地主管機關受理雇主接續聘僱外國人通報證明書 序號(有附則免填，填表說明注意事項四)
Number of the certificate on notifying consecutive employment of the foreigner to local authority (see notice 4)
接續日期
Date of consecutive employment
年 月 日
y/ m/ /d
持許可函 With the permit
招募許可函文號(有附則免填，填表 說明注意事項七)
Recruitment permit number (not required if the permit is attached, see notice 7)
入國引進許可函文號(有附則免填，
填表說明注意事項七)
Introduction permit number (not required if the permit is attached, see notice 7)
前任外國人資料(填表說明注意事
項二)
Previous foreigner’s information (see notice 2)
國籍 Nationality 護照號碼 Passport number
非持許可函 Without a permit
求才證明書編號(有附則免填，填表說明注意事項八)：
Recruitment certificate number (see notice 8):
公司(法人)需填寫聘僱辦法證明書序號： (有附則免填，填表說明 注意事項九)
The company (legal person) shall enter the Serial number of the certificate for employment (see notice 9):
□箱網養殖需填寫聘僱辦法證明書序號： (有附則免填，填表說明 注意事項九)
For cage culture, Serial number of the certificate for employment is required (see notice 9):
□箱網養殖檢附主管機關或目的事業主管機關核發或核定之箱網養殖漁業區劃漁業權 執照或專用漁業權入漁證明、本國箱網養殖勞工名冊正本(箱網養殖漁業類雇主符合勞 工保險條例規定無須設立勞工保險投保單位者，需經地方漁業主管機關驗章)
Proof of Demarcated fishing right holders of cage culture industry who have a license issued by the competent authorities, or exclusive fishing right holders with a certificate of fishery access for cage culture, list of local laborers of cage culture (In the case where the employer is eligible for exempt of labor insurance, local fishery authority is required)
□本國船員人數：＿＿＿＿人 (填表說明注意事項十二)；
Number of national seafarers (see notice 12)
□漁業人與船員無聘僱關係，檢附切結書如後附(切結事項)
Affidavit stating that the fishery operator and the seafarer have no employment (see the
affidavit on the back).
原雇主廢止聘僱許可或不予許可函文號(除三方合意外均須 填寫，填表說明注意事項七)或因疫情未能出國經本部同意轉 出函文號(有附則免填，填表說明注意事項十三)
Case number of the original employer’s revocation or rejection of employment permit. (Not required for three-party consent to consecutive employment, see notice 7) Or the approval letter number of transferring issued by the Ministry of Labor
for that the foreigner cannot go abroad due to the pandemic. (see notice 13)
同意外國人代雇主申請接續聘僱許可切結書 Authorization letter
雇主 （漁船統一編號： ）同意由本案外國人（護照號碼： ）代為 申請聘僱許可，並聲明本申請案所填寫資料及檢附文件等均屬實，如有虛偽，願負法律上之一切責任。
The employer_____________(CT number: ) authorizes the foreigner in this application______________(Passport number: ) to apply for the employment permit. Hereby to declare the information and documents provided to be true, and confirm with full legal responsibility for any perjuries found.
雇主： 負責人： （簽章）
Employer Responsible person (Signature)
雇主市內電話： (不得填列私立就業服務機構之聯絡資訊) Employer’s landline phone number:
(Cannot be the contact information of the private employment services institution.) 雇主行動電話： (不得填列私立就業服務機構之聯絡資訊) Employer’s mobile number:
(Cannot be the contact information of the private employment services institution.) 電子郵件e-mail：
□有 Yes:
□無 No
※以上 3 項聯絡資訊，請確實填寫，雇主應依規定就市內電話或行動電話擇一填寫提供雇主本人或可聯繫至雇 主之親友電話，如未確實填寫雇主聯絡電話，將不予核發許可。另聯絡資訊將作為本機關即時聯繫說明申請案 件審查情形及後續聘僱管理注意事項之用，以利縮短案件審查時間，與保障雇主聘僱外國人之權益！
Please fill in the three contact methods above. According to the regulations, the employer needs to provide either a mobile or landline phone number at which the employer (or a contact person) can be reached. If the contact information of the employer is not provided, the Ministry of Labor will not issue the permit. The contact information will be used for the authority when needed (to inform the status of the application or attentive matters). To shorten the processing time and guarantee the rights and benefits of the employers in hiring foreigners, please fill in the form properly.
中 華 民 國 年 月 日 Year month day
（以下虛線範圍為機關收文專用區）
(Document Reception Use Only)
收文章：
Receipt Stamp
收文號：
Case Number 填表說明注意事項：
Notice
一、 相關法規及申請程序，請依照本機關網站所載最新規定辦理。
1. Relevant regulations and application procedures, please follow the latest regulations on the website of Workforce Development Agency.
二、 外國人請填護照號碼，倘非首次來臺受聘且有護照號碼異動之情事，應立即向內政部移民署辦理居留資 料異動事宜。
2. Foreigners’ passport numbers are required. If the foreigners are not employed in Taiwan for the first time and have renewed the passport numbers, they have to immediately apply to the Immigration Agency of the Ministry of the Interior for the update of their information.
三、 外國人行動電話必填，且不得與雇主或委任私立就業服務機構電話相同，未填寫者，將退請補正確認；
電子郵件須勾選「有」或「無」，未勾選者，將退請補正確認，若勾選「有」，請確實填寫且不得與雇主
或委任私立就業服務機構電子郵件相同。
3. The foreigner’s mobile number is required and cannot be the same as the phone number of the employer or the appointed private employment services institution. If the phone number is not provided, the application will be returned for revision; the email section must be checked “Yes” or “No”, or else the application will be returned for revision. If you tick "Yes", please enter the email address and it must not be the same as the email of the employer or the appointed private employment services institution.
四、 接續聘僱通報證明書序號：範例 右上角 00000123456789 填寫為 00000123456789
4. Number of the certificate on notifying consecutive employment of the foreigner: ex. on the top right corner 00000123456789, please enter 00000123456789. You can leave this field blank if the certificate is attached in the application.
五、 審查費(公立就業服務機構：100 元，雙方或三方合意：200 元)收據：分為電腦收據(白色)及臨櫃繳款收 據(綠色或藍色)2 種，填寫如下：
5. There are two types of receipt of the application fee (100 NTD for public employment service institution; 200 NTD for two-party and three-party consent).
(1) 電腦收據(各郵局開具之白色收據)：
If you pay at the post office (a WHITE slip)
範例 00002660 110/06/11 16:46:33 00002660 110/06/11 Ex. 003110 1A6 297174
003110
填寫 繳費日期：110 年 6 月 11 日，郵局局號：003110，劃撥收據號碼(8 碼)：00002660
Fill in the form as follow: payment date: 110 y 06 m 11 d; branch code: 030110; receipt No. (8 digits): 00002660 (2) 臨櫃繳款收據(郵局派本機關駐點開具之綠色或藍色收據)：
If you pay at our office (a BLUE or GREEN slip) 範例 右上角 B-5103097，經辦局章戳 Ex. upper right corner B-5103097;
with the stamp of the post office
填寫 交易序號(9 碼)：B-5103097，繳費日期：110 年 6 月 11 日，郵局局號：000100 Fill in the form as follow
transaction No. (9 digits): B-5103097 ; payment date: 110 y 06 m 11 d ;branch code: 000100 六、 持重新招募入國引進許可函或遞補招募許可函申請者，須填寫前任外國人資料。
6. Previous foreigner’s information is required if you apply with introduction permit of re-recruitment or substitution recruitment permit.
七、 許可函文號：範例 勞○○○字第 1000641633 號，填寫為 第 1000641633 號 郵局局號 branch code 劃撥收據號碼(8 碼)
receipt No. (8 digits)
繳費日期
date
局號 000100-6 110.06.11
7. Employment permit number: ex. 勞○○○字第 1100641633 號, please enter 1100641633.
八、 求才證明書編號：範例 編號：A320702010120043 填寫為 A320702010120043
8. Recruitment certificate number: ex. 編號：A320702010120043, please enter A320702010120043.Leave this field blank if you have attached the certificate in the application.
九、 雇主聘僱外國人許可及管理辦法第22 條第 1 項第 5 款證明書(簡稱聘僱辦法證明書)序號：範例 右上角
123456789 填寫 123456789
9. Serial number of the certificate for employment: Documentary proof as stated in the Article 22.1.5 of Regulations on the Permission and Administration of the Employment of Foreign Workers. Ex. on the top right corner 123456789, please enter 123456789. You can leave this field blank if you have attached the certificate in the application.
十、 請據實填寫，如接續聘僱後海洋漁撈為自然人雇主死亡，請檢附死亡證明書影本。若他人於自然人雇主
死亡或漁船轉予新雇主後仍以其名義申請接續聘僱外國人，將以違反就業服務法第5 條第 2 項第 5 款規
定論處。
10. Please fill in the information according to the facts. If the employer (natural person) dies after the employment was taken over, please attach a copy of the death certificate. If another person applies to hire the foreigner in the original employer’s name after his/her death or after the fishing boat is transferred to a new employer, it will be in violation of Article 5.2.5 of the Employment Services Act.
十一、 󠄀請依實際情況勾選，如須檢附文件，務必檢附。依雇主申請招募第二類外國人文件效期、申請程序 及其他經中央主管機關規定之文件規定，申請文件除政府機關、醫療機構、學校或航空公司核發或開 具之證明文件外，應加蓋申請人或公司及負責人印章。
11. Please tick the boxes (□) accordingly, and do submit the required documents. Documents should include the stamps of the company and of the responsible person. (Documents issued by the government, school, health facility and airline are exempt.)
十二、請依所屬出海本國船員人數確實填寫。另依農委會規定，漁船本國船員人數至少應有1 人；又倘本國
船員有異動，請確實依農委會規定辦理本國船員異動登記，以正確核算名額。
12. Please enter properly in accordance with the number of the national seafarers going to sea. In addition, according to the regulations of Council of Agriculture, the number of the national seafarers should be at least 1 person. And if the number of the national seafarers has changed, you have to immediately apply to Council of Agriculture for the update of the latest number, so as to calculate properly the number of national seafarers.
切結事項：
Declarations
雇主與出海本國船員無聘僱關係切結如下：
The non-employment relationship of the employer and the domestic seafarer is written pledge as below:
十三、外國人原聘期屆滿，因疫情影響未能出國且雇主未辦理期滿續聘或期滿轉換，經本部同意轉換雇主或 工作之文號。
13. The foreigner's original employment period expires, but is unable to go abroad due to the pandemic and the employer has not applied for renewal or transferring at the expiration of the term. The approval letter’s number of changing jobs or employers issued by the Ministry of Labor. You can leave this field blank if you have attached the approval letter in the application.
本漁業人（漁船名稱： 號）與所屬本國船員係採合夥分紅制，故無法檢附工作地直轄
市、縣（市）政府開具雇主聘僱外國人許可及管理辦法第22 條第 1 項第 5 款證明書。特此切結
所填寫資料屬實，如有虛偽，願負法律上之一切責任。
Fishery operator (Name of the boat CT number) and those who belong to the member of national seafarers adopt the partnership dividend system, so they cannot attach the certificate issued by the municipal city government(s) at the municipal level, and the county/city government(s) at the County/City level according to Regulations on the Permission and Administration of the Employment of Foreign Workers Paragraph 5, Section 1 Article 22. Hereby to declare the information and documents provided to be true, and confirm with full legal responsibility for any perjuries found.
立切結書人：
Affiant
（單位圖記）Stamp of Company/Unit 漁業人姓名：Fishery operator Name （簽章）Signature 地址： Address:
中 華 民 國 年 月 日 Year month day
