外國人轉換雇主或工作申請書(中英雙語版)
Application Form for Transfer of Employer or Job
工作類別：
□1.製造工作 Manufacturing jobs
□2.營造工作 Construction jobs
□3.家庭看護工作 Family nursing job
□4.家庭幫傭工作 Housemaid jobs
□5.海洋漁撈工作 Ocean fishing work
□6.機構看護工作 Institutional nursing jobs
□7.屠宰工作 Slaughter work
□8.外展農務工作 Outreach agricultural job
□9.外展製造工作 Outreach manufacturing job
□10.農、林、牧、魚塭養殖工作 Agriculture, forestry, animal husbandry, or fish farming job
□11 外展看護工作 Outreach nursing jobs
□12.就業服務法第 46 條第 1 項第 11 款工作
Job Specified in the Item 11 to the paragraph 1 of Article 46 of Employment Services Act.
申請項目：
（公立就業服務機構專用）Purpose of Application: (For public employment service institution use only):
核准外國人轉換雇主或廢止原雇主之聘僱許 可，外國人經限期至公立就業服務機構辦理轉 換雇主
Approved transfer employers or revocation of foreign workers permit issued by the employer after the deadline for foreigners to apply the public employment service agencies to change employer.
申請人 Applicant
營利事業統一編號 Uniform Business No.
（身 分 證 字 號）
(Identification Card No.) (護照號碼) (Passport No.)
申請日期 Date of Application
年 月 日 YY MM DD
申 請 轉 出 國 別 與 人 數
Number and Nationality of Foreign Worker(s) Applied for Transfer 泰國（030）
Thailand
菲律賓（024）
Philippines
馬來西亞(019) Malaysia
印尼(009) Indonesia
越南(033) Vietnam
蒙古（021）
Mongolia
男 M
女 F
□ 本申請案無委任私立就業服務機構辦理或
No private employment service institution is assigned to handle matters related to this application; or
□ 本申請案係委任私立就業服務機構辦理（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。
The private employment service institution is assigned to handle the matters related to this application (please select either one). The applicant declares all the information and documents provided in the application are correct. Should this application be forged or should there be any falsity of the contents herein, the applicant is subject to relevant discipline or punishments in accordance with the relevant laws and regulations.
申請人： （單位圖記）
Applicant： (Seal of the Unit) 通訊地址：
Contact Address：
聯絡人： （簽章） 聯絡電話：( ) Contact Person： (Signature) Contact Phone No.: ( )
受委任私立就業服務機構名稱： （單位圖記）
Name of the Private Employment Service Institution Assigned: (Seal of the Unit):
許可證字號： 負責人： （簽章）
Registration No.： Person in Charge： (Signature) 通訊地址：
Contact Address:
專業人員： （簽名）
Service Personnel： (Signature) 聯絡人： 聯絡電話：( )
Contact Person： Contact Phone No.：( )-
（以下虛線範圍為公立就業服務機構收文專用區）
(The column below is for the public employment service institution use only) 收文章：
Seal of Recipient:
收文號：
Reference No.:
應檢附文件：
Documents required to be submitted:
□1.申請書。
Application form
□2.中央主管機關核准外國人轉換雇主或廢止原雇主之聘僱許可，並限期外國人轉換雇主或工作 之證明文件。
Documents issued by the central competent authority to certify that the employment permit to the original employer has been revoked and the foreigner has been required to transfer to another employer or job within specified time.
□3.外國人護照及居留證影本。
Photocopies of passport and alien residence certificate of the foreigner.
□4.外國人同意轉換雇主或工作之證明文件。
Documents certifying foreigner has agreed to transfer to another employer or job.
AF-T10
