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KR Form 1

This document is a registration form for domestic workers (kasambahays) in the Philippines. It collects personal information like name, address, contact details, civil status, age, education level, work details like salary and duties, and attachment of an employment contract. The kasambahay certifies that the information provided is true and may be used for legal purposes, and signs to authenticate their signature. The form is received by a kasambahay desk officer.

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DILG San Fabian
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1K views1 page

KR Form 1

This document is a registration form for domestic workers (kasambahays) in the Philippines. It collects personal information like name, address, contact details, civil status, age, education level, work details like salary and duties, and attachment of an employment contract. The kasambahay certifies that the information provided is true and may be used for legal purposes, and signs to authenticate their signature. The form is received by a kasambahay desk officer.

Uploaded by

DILG San Fabian
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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lxl photo

KR Form-l
KASAMBAHAY REGISTRATION FORM

INSTRUCTION: ACCOMPLISH IN TWO (2) COPIES KR NO. ITIIJ CIIIIJ


CHECK (...J ) THE APPROPRIATEBOXES (YYYY-5Numbers. Ex. 2013-00001)

1. PERSONAL INFORMATION

FIRST NAME MIDDLE NAME LAST NAME

EMPLOYER'S ADDRESS: _
(House No. / Street/ Subdivision/ Barangay/ City or Municipality/ Province)
HOME ADDRESS:
(House No'; Street/ Subdivision/ Barangay/ City or Municipality/Province)

SEX: 0 Male 0 Female CIVIL STATUS: 0 Single 0 Married 0 Widowjer 0 Separated


AGE: DATE OF BIRTH: (MMjDDjYYYY) CONTACT NO.: _
SSS No. PAG-IBIG 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
o Elementary Undergraduate o High School Graduate D Vocational
o Elementary Graduate o College Undergraduate
o High School Undergraduate o College Graduate

4. WORK INFORMATION

Monthly Salary: Php _


Nature of Work: o General Househelp o Yaya
o Cook o Gardener
o
Laundry Person o Others (PIs. specify)

Employment Arrangement: OLive-In OLive-Out


Name of Employer: _

5. ATTACHED DOCUMENT

o Kontrata sa Paglilingkod sa Tahanan

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

Signature of Kasambahay
Received by: _
Kasambahay Desk Officer
Date:

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