ASEANA CAREGIVERS
Live-In Caregiver Profile
PERSONAL INFORMATION
Name (as in Passport)
*
Date of Birth (DD/MM/YYYY)
*
/
Day
/
Month
Year
Date
Age
*
Place of Birth (Town/City and Country)
*
Nationality
*
Gender
*
Male
Female
Gender
Marital Status
*
Single
Married
Widowed
Divorced/Annulled
Separated
Marital Status
Religion
*
Christian
Catholic
Buddhist
Muslim
Hindu
Sikh
Others (please specify)
Other Religion
*
Religion
Height (cm)
*
Weight (kg)
*
Residential Address in Home Country
*
Name of Port / Airport to be Repatriated to (e.g. NAIA, Clark, etc.)
*
Whatsapp No / Mobile No.
*
Number of Siblings (e.g. "3 of 5" if you are the 3rd child out of 5 siblings including deceased siblings)
*
Number of Children
*
Age(s) of Children (if any)
*
HIGHEST EDUCATIONAL LEVEL (College/High School)
*For Caregiver Course or Care Related Short Courses, put in the Trainings Section
Highest Educational Level 1
Qualification
*
Name of School
*
Location
*
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Add Qualification?
*
Yes
No
Highest Educational Level 2
Qualification
Name of School
Location
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
TRAININGS AND SEMINARS ATTENDED
Trainings and Seminars 1
Title
Training Centre
Location
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Add Trainings and Seminars Attended?
*
Yes
No
Trainings and Seminars 2
Title
Training Centre
Location
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Trainings and Seminars 3
Title
Training Centre
Location
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
LICENSURE AND CERTIFICATION (e.g. PRC, TESDA, etc.)
Title
Institution
Location
Registration Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
CARE RELATED WORK EXPERIENCE
Work Experience 1
Job Designation
*
Company Name / Employer
*
Address
*
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Type of Patient (Age, Gender, Medical Condition and Mobility)
*
Duties
Reason for Leaving
Add Care Related Work Experience?
*
Yes
No
Work Experience 2
Job Designation
Company Name / Employer
Address
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Type of Patient (Age, Gender, Medical Condition and Mobility)
Duties
Reason for Leaving
Work Experience 3
Job Designation
Company Name / Employer
Address
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Type of Patient
Duties
Reason for Leaving
Work Experience 4
Job Designation
Company Name / Employer
Address
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Type of Patient
Duties
Reason for Leaving
INTERNSHIP / ON THE JOB TRAINING
Internship / OJT 1
Hospital / Care Institution
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Assigned Wards
Type of Patients Handled
Add Internship/On the Job Training?
*
Yes
No
Internship / OJT 2
Hospital / Care Institution
Start Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
End Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Assigned Wards
Type of Patients Handled
MEDICAL HISTORY/DIETARY RESTRICTIONS
Allergies (if any)
*
Past and existing illnesses (including chronic ailments and illnesses requiring medication)
Mental Illness
*
Yes
No
Epilepsy
*
Yes
No
Asthma
*
Yes
No
Diabetes
*
Yes
No
Hypertension
*
Yes
No
Tuberculosis
*
Yes
No
Heart disease
*
Yes
No
Malaria
*
Yes
No
Operations
*
Yes
No
Other Illnesses (please specify)
Physical disabilities
*
Previous and existing injury (if any)
*
Problem with Hearing or Eyesight (if any)
*
Dietary restrictions
*
Food handling preferences
*
No pork
No beef
No preference
Others (please specify)
Other Food handling preferences
*
Preference for rest day (number of rest days per month)
*
0
1
2
3
4
Preference for rest day
Any other remarks
SKILLS
Method of Evaluation of Skills
Based on Caregiver/FDW’s declaration, no evaluation/observation by Singapore EA or overseas training centre/EA
Interviewed by Singapore EA
If Interviewed by Singapore EA
Interviewed via telephone/teleconference
Interviewed via videoconference
Interviewed in person
Interviewed in person and also made observation of Caregiver/FDW in the areas of work listed in table
Caregiving/Nursing Skills
Choose one item that applies.
Basic Caregiving Skills
Toileting (diaper change, use of commode)
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Bathing (in the shower, bed bath)
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Personal Hygiene, Grooming, Dressing
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Transferring (bed to wheelchair and vice versa)
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Assist care recipient with Mobility Device
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Oral Feeding
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Management of Medication
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Meal Preparation
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Monitoring of Input and Output
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Provide passive range of motion exercises
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Taking, Monitoring and Recording Vital Signs
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
General Nursing Skills
NGT Feeding
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
PEG Feeding
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Urinary Catheter Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Stoma Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Glucose Monitoring and Management
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Wound Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Specialized Nursing Skills
Tracheostomy Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Suctioning
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Home Ventilation and Respiratory Support Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Dementia Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Palliative Care
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Medical Equipment Used
Choose one item that applies.
Catheter
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Colostomy Bag
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
CPAP Machine
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Medical Ventilator
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Nebulizer
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Peritoneal Dialysis Machine
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Pulse Oximeter
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Oxygen Concentrator
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Suction Machine
*
No Experience but Attended Training/Willing to Learn
With Some Experience (1-6 months)
With Good Experience (6-12 months)
With Very Good Experience (more than 12 months)
Types of Patients Handled
Elderly (you may choose more than one)
Alzheimer's Disease/Dementia
Arthritis
Cancer and/or Palliative Care
Chronic Kidney Disease (CKD)
Chronic Obstructive Pulmonary Disease (COPD)
Diabetes
Heart Disease
Hypertension
Motor Neuron Disease
Parkinson's Disease
Shingles
Spinal Chord Injury
Stroke
Others (please specify)
Other Elderly Medical Conditions Handled
*
Infant/Young Children (you may choose more than one)
Autism
Cancer
Cerebral Palsy
Chronic Kidney Disease (CKD)
Down Syndrome
Epilepsy
Others (please specify)
Other Infant/Young Children Medical Conditions Handled
*
AVAILABILITY OF FDW TO BE INTERVIEWED BY PROSPECTIVE EMPLOYER
FDW is not available for interview
FDW can be interviewed by phone
FDW can be interviewed by video-conference
FDW can be interviewed in person
OTHER REMARKS
Caregiver/FDW Name
Signature
*
Date (DD/MM/YYYY)
*
/
Day
/
Month
Year
Date
Employer Name
Employer Signature
Date (DD/MM/YYYY)
/
Day
/
Month
Year
Date
Answer the following questions truthfully and on the best of your knowledge
Are you willing to work as live-in caregiver in Singapore?
*
Yes
No
Are you willing to do household chores related to the patient?
*
Yes
No
Are you ok to use handphone only after working hours?
*
Yes
No
Are you willing to sleep in the same room as the patient?
*
Yes
No
Are you willing to wake-up in the middle of the night to change diaper and check vital signs?
*
Yes
No
Are you ok not to have straight 8 hours sleep?
*
Yes
No
Are you ok not to wear slippers inside the house on concrete/tiled flooring?
*
Yes
No
What is the weight of the heaviest patient you have handled on your own?
*
Are you willing to take care of patient with complex care (with NGT, Suctioning, Catheter Care, Stoma Care)?
*
Yes
No
What is your usual blood pressure reading?
*
Have you had any history of any form of back, shoulder or leg injury/pain?
*
Yes
No
Have you had any history of any form of arthritis, asthma, thyroid, mental illness, epilepsy, hypertension, diabetes, operations, tuberculosis, heart disease, malaria?
*
Yes
No
Specify the Illness
*
Have you had any history of any form of Sexually Transmitted Diseases?
*
Yes
No
Specify the Sexually Transmitted Disease
*
Have you had any history of any form of difficulty involving your senses: hearing, vision, smell, touch, and taste?
*
Yes
No
Specify the Sense/s
*
Do you have any allergies or food restrictions?
*
Yes
No
Specify the Allergies/Food Restrictions
*
Do you smoke or drink alcohol?
*
Smoke
Drink Alcohol
Both
No
Do you have any tattoos?
*
Yes
No
Have you worked overseas before?
*
Yes
No
List the Countries where you have worked previously other than your Home Country
*
Number of Years you have worked Overseas
*
Are you willing for your employer to keep your passport for safekeeping as long as you can borrow anytime?
*
Yes
No
How did you get to know Aseana Caregivers?
*
Search Engine
Facebook
Friends
Others
Specify how you get to know Aseana Caregivers
*
Are you willing to be processed under the Foreign Domestic Worker category?
*
Yes
No
Tick below
*
I confirm that I have answered the above questions truthfully.
I give my full consent to Aseana Caregivers Pte Ltd to place my profile in their website and other online platform, for the purpose of finding an employer, should I be shortlisted.
Name
*
Signature
*
Date (DD-MM-YYYY)
*
-
Day
-
Month
Year
Date
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Preferably in Scrubsuit. If Scrubsuit is not available, you may wear smart casual.
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Upload High School/College Diploma, Care Related Training Certificates, Passport Copy, License ID (if applicable)
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