eHomemakers - Helping People Help Themselves

eHomemakers' Application for Telework

eHomemakers’ Application for Telework

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Please answer the following questionnaire honestly. The information will be kept completely confidential. The purpose of the questionnaire is to match you with the most suitable work we can find for you.

Personal Particulars

Name

IC No.

Nationality

Malaysian

Foreign Spouse of Malaysian Citizen

Gender

Male

Female

Address

Postcode

State

For Klang Valley, please specify locations:

If Others, please specify:

Telephone No.

Mobile No.

Email Address

Age

30 to 40

40 to 50

50 to 60

60 to 70

Marital Status

Single

Married

Widowed

Divorced

Children

Number of children under 6

None

One

Two

Three

More than 4

Number of children between 7-12

None

One

Two

Three

More than 4

Number of children between 13-18

None

One

Two

Three

More than 4

Number of special children who need special/constant care

None

One

Two

Three

More than 4

Please specify special care needs (Eg: Down Syndrome, Spastic, Autistic)

Number of dependents (other than children, e.g. elderly parents, spouse with chronic illness) who needs your constant attention at home:

None

One

Two

Three

More than 4

Academic & Professional Qualifications

PMR

SPM

STPM

Tertiary

Other professional training, please specify:

Income-generation Sources

Are you currently working?

Part-time

Occasionally

Not working

If you are earning income, what kind of work do you do?

Personal Skills

Please check “Yes” or “No” for the following questions

	Yes	No
Are you able to travel to an office every day?
§ If yes, are you able to arrange for your own transport to work? i.e. can you drive yourself/ can you take public transport/ can a relative drive you? § If no, please explain your condition in extra space provided below

Do you need special transport arrangement like a disabled friendly van?
Can you sit for more than 3 hours straight?
Are you able to read find print or computer screen without any difficulties?
Do you need to use bifocals in order to read fine print, read computer screen text or for typing?
Are you able to use your hands for typing for more than 1.5 hours straight?
Are you able to use your hands on detailed work (e.g. sewing) for more than 3 hours straight?
Are you able to focus on your job for more than 3 hours straight?
Can you work independently?
Are you able to work in a social environment/mix with people comfortably?
Do you have space at home for a desk?
If yes, does your desk at home have enough space for:
a) computer?
b) fax machine?
c) printer?
Do you have a home computer?
Do you have internet connection at home?
Do you have VOIP or Skype?
Your concerns:

Please list & describe any specific skills/knowledge/hobby

Skill	Yes	No	Please give more details
Public relations
Customer service
Cooking
Photography
Sales/marketing
Handicraft related
Related to art and design
Related to environment
Related to animals
Related to reading and writing
Related to research
Related to automobile
Related to engineering
Related to agriculture/farming
Related to nursing/caring
Phone counselling
Others	1.
	2.
	3.
	4.
	5.

Please describe any volunteer work (if any) that you do

Availability
How many hours per week can you work?
Fewer than 10	11- 20		20-30
30-40	40-50
How many hours per day can you work?
Fewer than 3		Fewer than 5
6-8		9-12

Preferred Work Hours

Hours	Mon	Tues	Weds	Thurs	Fri	Sat	Sun
AM
PM

Special Conditions

Do you experience any of the following problems? (eHomemakers will try to get work from companies that practice CSR (corporate social responsibility)

	Yes	No
Chronic illness that requires regular medical checkups
Depression/mental breakdown
Critical illness that requires periodic hospitalisation
Inability to concentrate
Inability to sit for more than two hours at a time
Visually-impaired
Hearing-impaired
Speech-impaired
Mental and physical abuse
Any other illnesses or constraints that might affect your work?

Others: Any other issues that you think are important that we should know (other commitments, concerns, interests).

Work Experiences

Starting with your present post, list in reverse order every employment you have had. If you need more space, please attach additional pages

From (MM/YY)	To (MM/YY)	Name of Employer

Reason(s) for leaving
1.
2.
3.
Type of work & description of duties (Eg: administrative, data entry, marketing/ sales, clerical, inventory
1.
2.
3.
4.
5.

From (MM/YY)	To (MM/YY)	Name of Employer

Reason(s) for leaving
1.
2.
3.
Type of work & description of duties (Eg: administrative, data entry, marketing/ sales, clerical, inventory
1.
2.
3.
4.
5.

From (MM/YY)	To (MM/YY)	Name of Employer

Reason(s) for leaving
1.
2.
3.
Type of work & description of duties (Eg: administrative, data entry, marketing/ sales, clerical, inventory
1.
2.
3.
4.
5.

From (MM/YY)	To (MM/YY)	Name of Employer

Reason(s) for leaving
1.
2.
3.
Type of work & description of duties (Eg: administrative, data entry, marketing/ sales, clerical, inventory
1.
2.
3.
4.
5.

Work-related Skills

Do you have experience in the following tasks?

Skill Set		Yes	No	If Yes, no. months or years
Answering phones, taking messages, directing calls
Listing callers’ names, contacts and reason for calling into a computer spreadsheet?
Conducting customer care follow-up (e.g. follow up on caller requests, gather additional information from customers, payments follow-up)?
Answering emails and managing folders
Writing company notes/ memos
Office administration – e.g. call for maintenance, supplies, compile receipts, manage mail
Organisation of documents - e.g. folder filing, classifying and retrieving documents
Organising and managing boss’ schedule - e.g. book transportation, arrange schedules and reminders
Accounting responsibilities- pay bills, keep & track records, submit monthly reports, simple calculations
Familiarity with the following software	Microsoft Word
	Microsoft Excel
	Microsoft PowerPoint
	Outlook Express
Data entry (online)
Surfing the web (finding out information from the internet)

Typing Skills

Approximately how many minutes/hours do you take to type one A4 page, double-spaced?

Languages

Please list languages and dialects that you know (Those who speak and write foreign languages are especially encouraged to apply.)

Language/ Dialect	Understand Easily		Speak Fluently		Read Easily		Write Well
Language/ Dialect	Yes	No	Yes	No	Yes	No	Yes	No
1.
2.
3.
4.
5.
6.