Comma separated values if multiple

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rest day(s) per month

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

If yes, state the no. of years

Please state qualitative observations of FDW and/or rate the FDW (indicate N.A. of no evaluation was done) Poor ........................Excellent...N.A 1 2 3 4 5 N.A

From * To * Country *

(including FDW’shome country)

Employer * Work Duties * Remarks
1

(The EA is required to obtain the FDW’s employment history from MOM and furnish the employer with the employment history of the FDW. The employer may also verify the FDW’s employment history in Singapore through WPO Lusing Sing Pass)

From * To * Country *

(including FDW’shome country)

Employer * Work Duties * Remarks
1

Feed back was/ was not obtained by the EA from the previous employers. If feedback was obtained (attach testimonial if possible), please indicate the feedback in the table below:

Employer * Feedback * Attachment
1

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