AF-T14 1051116 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 regulation.
1. 被看護者 Original patient□a.死亡 dies□b.移民 emigrates.
2. 原雇主 Original employer □a.死亡 dies□b.移民 emigrates 3. □船舶被扣押、沉沒或修繕而無法繼續作業者。
The vessel he/she works on has been detained, sunk, or under repair so as to compel the discontinuation of the work.
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。
The discontinuation of the work caused in the fact that his/her original employer has wind up the factory, suspended the business, or failed to pay the wage/salary pursuant to the employment contract resulting in the termination thereof.
5. □其他不可歸責於受聘僱外國人之事由者。
Other than the above, similar circumstances not attributable to the employed foreign worker.
6. □家庭外籍看護工經雇主同意轉換雇主或工作。
The foreign caretaker transfers to a new employer or work with former employer’s agreement 7. □雇主與外國人協議期滿不續聘：
Employer and foreigners agree not renew the employment when the contract end.
外國人希望工作區域 (請填寫縣市) 聯絡電話 Foreigners want to work area( Please fill in cities and counties) Contact telephone number 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籍勞工轉換雇主網路作業系統。
If you don’t fill in the desired work area, The current work address of foreign counties and cities login to the system of foreign worker transfer employer.
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。
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 cannot attend council、cannot transfer a new employer or jobs must to terminate the employment relationship 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 end. 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 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。
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。
