AF-041 1110430 版
雇 主 聘 僱 外 國 人 申 請 書
APPLICATION FORM FOR EMPLOYMENT OF FOREIGNERS
案件類別：
Type of Application
62.依就業服務法第 51 條聘僱外國人 In accordance with Article 51 of the Employment Service Act
申請項目：
Applying Item
□21.聘僱許可 Employment Permit
雇主名稱
Name of Employer
營利事業統一編號（身分證字號）
Corporate Uniform No.(I.D No.) 雇主公司地址
Address of Employer
□□□（郵遞區號） 縣 鄉鎮 路 段 巷 弄 號 樓
□□（縣市別代碼） 市 市區 街
外國人姓名 Foreigner Name
英文 English
中文 Chinese 國 籍 Nationality 護照號碼 Passport Number
性 別 Sex 出生日期 Date of Birth 年 Y 月 M 日 D
行 動 電 話
mobile phone number (必填，填表說明注意事項五)
(required, see notice 5)
電 子 郵 件
E - m a i l
(填表說明注意事 項 五) ( s e e n o t i c e 5 )
□有：
□無
審查費收據
(免附，填表說明注意事項二) Receipt for application fee (needn’t submit; reference on the back as for how to fill in the form)
繳費日期 Payment date
年 月 日 y/ m/ /d
郵局局號(6 碼) Branch code 劃撥收據號碼(8 碼)或交易序號(9 碼) Receipt No.(8 digits) or transaction No.(9 digits)
外國人身 分別 Foreigner status
□獲准居留之難民。
A refugee permitted to stay in the Republic of China.
□獲准在中華民國境內連續受聘僱從事工作，連續居留滿五年，品行端正，且有住所者。
One who has been continuously employed, with permission of the relevant competent
authority(ies), to engage in work in the Republic of China, has maintained a settled practice of good-mannered behavior, and has kept a residence in the said territory for at least five
consecutive years
□經獲准與其在中華民國境內設有戶籍之直系血親共同生活者。
One permitted to live with his/her lineal relative who has a registered domestic residence in the Republic of China.
□經取得永久居留者。
One permitted to stay permanently in the territory of the Republic of China.
最近入國日期
Most Recent Entry Date 年 Y 月 M 日 D 居留證有效期限
Expiration Date of Resident Visa
年 月 日止
Y M D
受聘僱期間
Period of Employment
自 年 月 日至 年 月 日止
From Y M D to Y M D
受僱擔任之工作內容 Nature of Work
以下文件請依實際情況勾選檢附：
□負責人身分證影本 1 份
One copy of the Responsible Person's Identification Card.
□外僑居留證（或永久居留證）正反面影本各 1 份。
One copy of both sides of Alien Resident Visa (or Permanent Resident Visa).
AF-041 1110430 版
□護照影本 1 份。
One copy of Passport.
□聘僱合約書影本 1 份。
One photocopy of Employment Contract.
□難民證影本。(獲准居留之難民需檢附)
Photocopy of Refugee Certificate.(Applicable of refugees permitted to reside.)
□當地內政部入出國及移民署（服務站）開立之外僑居留滿 5 年入出境證明影本。《獲准在中華民國境內
連續受聘僱從事工作，居留滿五年，品行端正，且有住所者需檢附》
Photocopy of Certificate for foreigner's residence up to 5 years (certificate of entry and exit), issued by local National Immigration Agency. 《Applicable to persons of exemplary behavior who have been continuously employed, and resided in the Republic of China for up to five years.》
□雇主開立之連續 5 年的聘僱證明及政府主管機關核發連續滿 5 年的聘僱許可文件證明影本。《獲准在中
華民國境內連續受聘僱從事工作，居留滿 5 年，品行端正，且有住所者需檢附》
Continous 5-year employment certificate issued by employer and continuous full 5-year employment permit Certification issued by the competent authority. 《Persons of exemplary behavior who have been continuously employed, and resided in the Republic of China for up to five years.》
□受聘僱外國人配偶最近 3 個月內之戶籍謄本正本。《與在中華民國境內設有戶籍之國民結婚，且獲准居
留者需檢附》或直系血親共同生活者 3 個月內之戶籍謄本正本。
One original most recent 3-month household registration transcript for the employed foreigner's spouse.
《Applicable to who marries a national of the Republic of China with domestic residence and a permit to reside.》or one original most recent 3-month household registration transcript of lineal relatives living with the Employed.
本申請案 □無 或 □有委任私立就業服務機構辦理；□本申請案蓋用之圖記、印信確為雇主授權使用 或授權代刻；文件回復方式：□親取或□郵寄（□私立就業服務機構地址□外國人居住地址□其他地 址： ）， (以上請擇一勾
選)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。
This application has been entrusted to a private employment services agency to apply. □ no □ yes
□The making and using of the stamp, seal in this application has been authorized by the employer.
I would like □ to pick up the official document; □ to have the official document deliver to (□ address of the private employment services agency；□foreigner’s resident address; □other
address:__________________________________________________________. Please select from one of the above). Applicant shall assume legal responsibly for providing information and documents proven false through investigation.
雇主名稱： （單位圖記）
Name of Employer Chop
負責人： （簽章）性別： 出生年月日： 身分證字號碼：
Responsible Person Signature and personal seal
聯絡人： 聯絡電話：( )-
Liaison Tel:
市內電話： （不得與委任之私立就業服務機構聯絡電話相同）
Tel
行動電話： （不得與委任之私立就業服務機構聯絡電話相同）
Mobile phone number
電子郵件：□有: □無 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。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 enter the three contact methods above. The employer shall, according to the regulations, 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 matters needing attention). To shorten the processing time and for the right and benefit of hiring foreigners, please fill out the form properly.
受委託私立就業服務機構名稱： （單位圖記）
Name of the Manpower Agent Entrusted Chop 許可證號：
專業人員： （簽名） 證號： 聯絡電話：( )- Specialist Signature License No. Tel:
AF-041 1110430 版
（以下處線範圍為受理機關收文專用區）
收文章： 收文號：
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。
Relevant regulations and application procedures, please follow the latest regulations on the website of workforce development agency.
二、 繳交審查費之郵政劃撥單收據正本或可至本機關(10042 臺北市中正區中華路一段 39 號 10 樓)收費櫃 台現場繳交。《每人新臺幣 100 元整》戶名：勞動部勞動力發展署聘僱許可收費專戶。劃撥帳號：
19058848
Please submit the original of the receipt for Postal Giro or personally get to the counter of the Workforce Development Agency to made the payment. (NT$100 per person.)
Account Name: 勞動部勞動力發展署聘僱許可收費專戶。 Post Account No.:19058848 審查費(100 元)收據：分為電腦收據(白色)及臨櫃繳款收據(綠色)2 種，填寫如下：
(1)電腦收據(各郵局開具之白色收據)：
範例 00002660 100/06/11 16:46:33 00002660 100/06/11 003110 1A6 297174
003110
填寫 繳費日期：100 年 6 月 11 日，郵局局號：003110，劃撥收據號碼(8 碼)：00002660 (2)臨櫃繳款收據(郵局派本機關駐點開具之綠色收據)：
範例 右上角 B-5103097，經辦局章戳
填寫 交易序號(9 碼)：B-5103097，繳費日期：100 年 6 月 11 日，郵局局號：000100 There are two kinds receipt of the application fee (100 NTD each case)
(1)If the applicant pay the fee at the post office before submitting the application (a WHITE slip) example
00002660 100/06/11 16:46:33 00002660 100/06/11 003110 1A6 297174
003110 fill in the form as follow
payment date: 100 y 06 m 11 d ; branch code: 030110 ; receipt No.(8 digits): 00002660
(2)If the applicant pay the fee at the counter while submitting the application in person (a GREEN slip)
example upper right corner B-5103097;
with the stamp of the post office
fill in the form as follow
transaction No.(9 digits): B-5103097 ; payment date: 100 y 06 m 11 d ;branch code: 000100 三、 請依實際情況勾選□，如須檢附文件，務必檢附。
Please tick the boxes (□) accordingly, and do submit the required documents.
四、 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，應加蓋公司及負責人 印章。
Documents should include the stamp the entity and of the owner by which the document was issued. Documents issued by the government, school, health facility and airline are exempt.
五、 外國人行動電話必填，且不得與雇主或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 雇主或私立就業服務機構電子郵件相同。
The foreigner’s mobile number is required and cannot be the same as the phone number of the employer or the 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 private employment services institution.
branch code
000100-6 100.06.11
郵局局號
劃撥收據號碼(8 碼) 繳費日期
局號
