雇 主 聘 僱 外 國 人 申 請 書 （外國人代為申請，中英文版）
APPLICATION FORM FOR EMPLOYMENT OF FOREIGNERS (For foreigner to apply on behalf of the employer)
工作類別：30 家庭看護工 Category: Caregiver
申請項目：接續聘僱許可
Applying Item: consecutive employment permit 63 期滿轉換
Applying Item: Finish contract and transfer
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
(請擇一勾選，填表說明注意事項三) e-mail
(Tick one of the boxes, see notice 3)
菲律賓
The Philippines
□有 Yes:
□無 No
本申請案回復方式：□親取 □郵寄至外國人工作地址(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 雇主身分證字號
(有附則免填，填表說明注意事項五、六) Employer’s ID number (see notice 5,6)
審查費收據
(有附則免填，填表說明 注意事項七) Receipt of application fee
(see notice 7)
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)
□招募許可函文號(有附則免填，填表說明注意事項八) Recruit permit number (see notice 8)
□原聘僱或接續聘僱許可函文號 (有附則免填，填表說明注意事項九) (Consecutive) employment permit number (see notice 9)
簽署日 (填表說明注意事項十)
Signed date (see notice 10)
年 y
月 m
日 d 外國人工作地址
(請擇一勾選，填表說明注意事項四)
work address
(tick one of the boxes, see notice 4)
□同招募許可函 same as stated in the recruitment permit
□為第 3 地(需檢附被看護者居住證明文件)
Other address (the care recipient's proof of residence is required.)
請 詳 閱 背 面 填 表 說 明notice on the back
就業安定費帳單寄送地址 (請擇一勾選) mailing address for employment
security fees bill (select one)
□同外國人工作地址 same as the work address
□其他地址(需檢附證明文件)
Other address (documentary proof is required.)
接續聘僱期滿轉換通報證明書序號(有附則免填，填表說明
注意事項十一)
Number of the certificate on notifying consecutive
employment of the foreigner for conversion expiration (see notice 11)
聘前講習證明序號 (有附則免填，第一次擔任雇主者需填
寫，填表說明注意事項十二)
Certificate number of the employer training session (Required for first time employer, see notice 12)
聘前講習上課者之配偶或被看護者之配偶身分證字號(聘前講習上課者與被看護
者為婆媳、翁婿等關係時始需填寫，填表說明注意事項十三)
ID number of the spouse of the care recipient or ID number of the spouse of the training session taker. (see notice 13)
應檢附文件： Required document:
□雇主身分證影本。
Employer’s ID certificate
同意外國人代雇主申請聘僱許可切結書 Authorization letter
雇主 （身分證字號： ）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_____________(ID number: ) authorize the foreigner in this application______________(Passport number: ) to apply for the employment permit on my behalf. I hereby declare the information and documents provided to be true, and confirm with full legal responsibility for any perjuries found.
雇主： （簽名）
Employer (Signature)
雇主市內電話： 雇主行動電話：
Employer’s landline phone number Employer’s mobile number:
雇主電子郵件：
Employer’s e-mail
※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 申請至 14 年評點
For accumulated working period to be 14 years
□是 Yes □否 No (請擇一勾選)
(tick Yes or No)
□雇主聘僱外籍家庭看護工之工作期間累計至 14 年之評點申請書正本及相關
文件。(外國人累計在臺工作期間詳參填表說明注意事項十四)
The assessment table and related documents for the employed foreign caretaker’s accumulated working period to be 14 years. (Accumulated working period, see notice 14)
（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
切結事項：代雇主參加聘前講習切結書
Affidavit 1 - Attending the employer training session on behalf of the employer
代參加講習人員姓名： 〈身分證字號： 〉與被看護者〈或被 照顧者〉具規定之親屬關係： 〈請填寫如父母、子女・・・等〉，且具與被看 護者〈或被照顧者〉共同居住或代雇主對外國人行使管理監督地位，特此切結。
I______________(ID number: ), the person attending the orientation on behalf of the employer, has one of the relationship with the care recipient as stated in the regulation:_________________________ (such as father, mother, son, daughter, etc.) and am cohabited relative of the care receiver or am exercising the management and supervision over the foreign worker on behalf of the employer.
代參加講習人員簽章：
Signature
中 華 民 國 年 月 日
Year Month Day
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、新任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. First time applicant must provide the passport number. If you are not employed in Taiwan for the first time and has renewed your passport number, you should immediately apply to the Immigration Agency of the Ministry of the Interior for the update of your information.
三、新任外國人行動電話必填，且不得與雇主電話相同，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. 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.
四、外國人工作地址為被看護者之居住地址，請勾選「同招募許可函」，或「第 3 地」並檢附被
看護者居住證明文件正本。(如為養護機構地址或與實情不符者，將撤銷聘僱許可)。
4. If the foreigner’s working address is the residence address of the care recipient, please tick "
same as stated in the recruitment permit ". The care recipient 's proof of residence is required if you tick "other address". (If it is the address of a nursing facility or does not match the actual condition, the employment permit will be revoked).
五、雇主及被看護者為本國人請填身分證字號，雇主及被看護者為外國人請填護照號碼。
5. If the employer/care recipient is Taiwanese, please enter the ID number; for foreigners, please enter the passport number. You can leave this field blank if the employer’s ID or passport is attached in the application.
六、請據實填寫，如簽署期滿轉換後雇主或被看護者死亡，請檢附死亡證明書影本。若他人於雇 主死亡後仍以其名義簽署接續聘僱期滿轉換外國人或雇主於被看護者死亡後仍簽署接續聘 僱期滿轉換外國人，將以違反就業服務法第 5 條第 2 項第 5 款規定論處。
6. Please fill in the information according to the facts. If the employer (or the care recipient) 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, it will be in violation of Article 5.2.5 of the Employment Services Act.
七、審查費(200 元)收據：分為電腦收據(白色)及臨櫃繳款收據(藍色)2 種，填寫如下：
7. There are two types of receipt of the application such as a WHITE slip and a BLUE slip (200 NTD).
(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藍色收據)：
If you pay at our office (a BLUE 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 八、招募許可函請務必檢附正本。
8. Please provide the original copy of the recruitment permit. You can leave this field blank if the permit is attached in the application.
九、許可函文號：範例 勞○○○字第110064163號填寫為 第1100641633號。
9. Employment permit number: ex. 勞○○○字第1100641633號, please enter 1100641633.
You can leave this field blank if the employment permit is attached in the application.
十、簽署日為雇主接續聘僱期滿轉換外國人者，與外國人簽署雙方合意接續聘僱證明文件之日 期。
10. The date of the employer and the foreigner signed the agreement for consecutive employment.
十一、 當地主管機關核發雇主接續聘僱期滿轉換外國人通報證明書(簡稱接續聘僱期滿轉換通報 證明書)序號：範例 右上角 00000123456789 填寫為00000123456789
11. Number of the certificate on notifying consecutive employment of the foreigner for conversion expiration. Ex. on the top right corner 00000123456789, please enter 00000123456789. You can leave this field blank if the certificate is attached in the application.
十二、 聘前講習證明序號：第一次擔任雇主聘僱外國人者需填寫，範例 編號702010120043 填寫 為 702010120043。非雇主本人參加講習者，需檢附代雇主參加講習人員屬共同居住親屬 或代雇主行使外國人管理監督地位之證明文件或切結書(切結事項)。
12. Certificate number of the employer training session: required for first time employer, ex. 編 號702010120043, please enter 702010120043. The persons who attend the training session on behalf of the employer shall provide the certificate or statement (Affidavit 1) for cohabited relative or exercising the management and supervision over the foreign worker on behalf of the employer. You can leave this field blank if the certificate is attached in the application.
十三、 為減少雇主辦理申請案所需檢附文件，本部將依申請書所填身分證字號及關係逕向戶政機 關查驗相關人員親等關係及基本資料，又親屬關係可由本部自戶政機關查知者，得免附戶 籍資料。另關係為婆媳、翁婿、孫媳婦、孫女婿等，因其親屬型態建立於婚姻關係，故需 填寫配偶身分證字號。
13. In order to reduce the number of documents that employers need to provide, the Ministry of Labor will check the family relationship and basic information of the relevant personnel with
劃撥收據號碼(8 碼) receipt No. (8 digits)
郵局局號 branch code
繳費日期 date
局號 000100-6 110.06.11
the household registration authority according to the ID number and relationship filled in the application form. In the case where the family relationship can be checked by the Ministry from the household registration authority, household registration documents could be exempt. For any relatives by marriage, the spouse’s ID number is also required.
十四、 工作期間累計至14年之評點：外國人受聘僱從事就業服務法第46條第1項第8款至第10款工 作，累計工作期間屆滿12年或累計工作期間在1年內屆滿12年，外國人從事家庭看護工工 作經專業訓練或自力學習，而有特殊表現，符合規定資格及條件者，工作期間累計不得逾 14年。
14. Assessment for accumulated working period to be 14 years: According to Paragraph 8 to 10, Section 1 of Article 46 of the Employment Services Act，foreigners who have worked in Taiwan for twelve years or will have worked for twelve years within one year to engage in caregiver may be allow to work to accumulated working period up to fourteen years, given the foreign worker has met the criteria (such as having special performance with professional training or self-learning).
十五、 □請依實際情況勾選，如須檢附文件，務必檢附。
15. Please tick the boxes (□) accordingly, and do submit the required documents.
十六、 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。
16. According to the related regulations, documents should include the stamps of the company and the stamps of the responsible person. (Documents issued by the government, school, health facility and airline are exempt.)
