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KR Form 1

This document is a registration form for domestic workers (kasambahays) in the Philippines. It collects personal information about the domestic worker like name, address, contact details, civil status, age, education level, work details, and attached documents. The domestic worker certifies that the information provided is true and accurate and can be used for legal purposes. The form is received by a kasambahay desk officer.

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dilg.apayao.luna02
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108 views

KR Form 1

This document is a registration form for domestic workers (kasambahays) in the Philippines. It collects personal information about the domestic worker like name, address, contact details, civil status, age, education level, work details, and attached documents. The domestic worker certifies that the information provided is true and accurate and can be used for legal purposes. The form is received by a kasambahay desk officer.

Uploaded by

dilg.apayao.luna02
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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KR Form- 1
KASAMBAHAY REGISTRATION FORM

INSTRUCTION: ACCOMPLISH IN TWO ( 2 ) COPIES KR NO. M i l l I I I 1 1 1


CHECK ( V ) THE APPROPRIATE BOXES (YYYY-5 Numbers. Ex. 2013-00001)

1 . PERSONAL INFORMATION

FIRST NAME MIDDLE NAME LAST NAME

EMPLOYER’S ADDRESS:
(House No. / Street / Sulxiivision/ Barangay/ City or Municipality / Province)
HOME ADDRESS:
(House No./ Street / Subdivision/ Barangay / City or Municipality / Province)

SEX: Male Female CIVIL STATUS: Single Married Widow / er Separated


AGE: DATE OF BIRTH: ( MM / DD / YYYY) CONTACT NO.:
SSS No. PAG - 1 BIG No. PhilHealth No.

2. FAMILY INFORMATION
NAME OF SPOUSE: CONTACT NO ..
FATHER ’S NAME: ADDRESS:
MOTHER ’S NAME: ADDRESS:
IN CASE OF EMERGENCY , CONTACT PERSON: CONTACT NO.

3. EDUCATIONAL INFORMATION
Highest Educational Attainment
1 1 Elementary Undergraduate I I High School Graduate Vocational
Elementary Graduate College Undergraduate
I I High School Undergraduate I 1 College Graduate

4. WORK INFORMATION

Monthly Salary: Php


Nature of Work: I 1 General Househelp I 1 Yaya
Cook 1 1 Gardener
I 1 Laundry Person I I Others ( Pis. specify )

Employment Arrangement: I I Live- In I 1 Live-Out


Name of Employer:

5. ATTACHED DOCUMENT

I I Kontrata sa Paglilingkod sa Tahanan

I hereby certify that the above information are true and correct and may be used for any
legal purpose. I further certify that my signature appearing herein is genuine and authentic.

Signature of Kasambahay
Received by:
Kasambahay Desk Officer
Date:

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