□外國人、原雇主及新雇主三方合意 接續聘僱證明書(中英雙語版)

Employer transfer certificate based on foreign worker、original employer、and new employer’s agreement

□外國人及新雇主雙方合意 接續聘僱證明書(中英雙語版)

Employer transfer certificate based on foreign worker and new employer’s agreement

新雇主名稱 New employer’s name
新雇主統一編號或身分證字號 New employer’s register No. or ID No.	聯絡電話 Contact Tel.
外國人姓名 Foreign worker’s name	護照號碼 Passport No.
原雇主名稱 Original employer
原雇主統一編號或身分證字號 Original employer’s register No. or ID No	聯絡電話 Contact Tel.
原雇主有下列情事之ㄧ（請擇一勾選），本人（外國人）自 年 月 日（接續聘僱起始日）起由新雇主接續聘僱，並自接續聘僱起始日負雇主責任、繳納就業安定費及依相關規定辦理： In case that original employer has the following situation (please choose one), I am willing to transfer to a new employer in accordance with related regulation since Year Month Day 雇主有下列情事之ㄧ（請擇一勾選），本人（外國人）同意轉換雇主或工作，並願依相關規定辦理： In case that employer has the following situation (please choose one), I am willing to transfer to a new employer or work in accordance with related regulation. 1.被看護者Original patient□a.死亡dies□b.移民emigrates.（不可申請遞補招募許可）(It is not allowed to apply for recurrence letter of recruitment). 2.原雇主Original employer □a.死亡dies□b.移民emigrates.（不可申請遞補招募許可）(It is not allowed to apply for recurrence letter of recruitment). 3.□船舶被扣押、沉沒或修繕而無法繼續作業者。（不可申請遞補招募許可） The vessel he/she works on has been detained, sunk, or under repair so as to compel the discontinuation of the work. (It is not allowed to apply for recurrence letter of recruitment). 4. □雇主關廠、歇業或不依勞動契約給付工作報酬經終止勞動契約者。（不可申請遞補招募許可） The discontinuation of the work caused in the fact that his/her original employer has wind up the factory, suspended the business, or failed to pay the wage/salary pursuant to the employment contract resulting in the termination thereof. (It is not allow to apply recurrence letter of recruitment.) 5. □其他不可歸責於受聘僱外國人之事由者。（不可申請遞補招募許可） Other circumstances do not attributable to the employed foreign worker. (It is not allowed to apply for recurrence letter of recruitment). 6. □外籍家庭看護工經原雇主同意轉換雇主或工作。（可申請遞補招募許可） Through the agreement of the employer, household caregivers are allowed to change employers or jobs. (It is not allowed to apply for recurrence letter of recruitment). 備註：1.勾選第6項外國人轉換理由，原雇主可依就業服務法第58條第2項第3款規定向本部申請遞補招募許可。(中階技術外籍家庭看護工轉換不適用) 2.本證明書1式5份，外國人、原雇主及新雇主各收執1份，新雇主應於合意接續聘僱外國人之日起依規定通知當地主管機關實施檢查及向中央主管機關申請接續聘僱許可。 3.原雇主所聘僱之外國人如逾期健檢，或未辦理健檢，或新雇主無法取得外國人之健檢資料者，新雇主應自接續聘僱外國人之日起7日內，安排承接之外國人至衛生福利部指定之醫院接受健康檢查。 Notice: 1. if the item 6 is selected, according to Paragraph 3, Section 2, Article 58 of the Employment Services Act. (Not applicable to intermediate Skilled Caregiver), the original employer may apply to the Ministry of Labor for recurrence letter of recruitment. 2. This certificate has 5 copies in total，one for the foreigner, one for the original employer and one for the new employer. From the date of agreed consecutive employment, the new employer must notify the local Competent Authority to implement inspection and apply to the Central Competent Authority for the consecutive employment permit. 3.If during the recruitment period at the original employer's home, the medical examination of the foreign worker is already overdue or has not undergone, or the new employer cannot obtain the medical examination information of the foreigner, the new employer must take the foreign worker to the hospital designated by the Ministry of Health and Welfare for a health check within 7 days from the date of consecutive employment.
家庭看護工專用欄位 Section for domestic helper	新雇主資格： Qualification of the new employer: □有效期限內之招募許可函 A valid recruitment letter of permit □合格醫院開具1年內之病症暨失能診斷證明書 Medical Certificate of Illness and Disability Issued Within One Year by an Accredited Hospital □有效期限內之身心障礙證明（特定身心障礙項目之一者） Disability proof within validity period (Persons with one of items for specific physical and mental disabilities). □符合長期照顧服務申請及給付辦法第7條及第9條附表四，且由各級政府補助使用居家照顧服務、日間照顧服務或家庭托顧服務連續達6個月以上者 Those who have been assessed as having long-term care needs of article 7 or 9 (chart 4) and have continued to use care services for more than six months from the date of approval of long-term care services. □經醫師開立診斷證明書，符合中央主管機關公告之病症或病況者 A medical certificate issued by a licensed physician indicating that the patient is diagnosed with an illness or condition as publicly announced by the central competent authority. □被看護者1年內曾受從事家庭看護工作，或中階技術家庭看護工作之外國人照顧者 The care recipient has received care within the past year from a foreign national employed as a caregiver or a mid-level skilled caregiver. □被看護者年齡滿80歲以上，雇主持其身分證明文件 The care recipient is aged 80 or above, the employer holds identification documents proving the care recipient’s status. □雇主申請聘僱外國人從事中階技術家庭看護工作，被看護者符合外國人從事就業服務法第46條第1項第8款至第11款工作資格及審查標準第61條規定免經醫療機構專業評估之情形 Diagnosis certificate for employer who applies for foreigner to be the household caregiver will be exempted if the employment qualifications for the foreign worker engages in work specified in subparagraphs 8 to 11, Paragraph 1, Article 46 of the employment services act and Article 61 of Review Standards. （本欄位請務必勾選，並請檢附招募許可函、診斷證明書或身心障礙證明影本，俾憑認定） Please be sure to tick this field, and must attach a copy of the recruitment permit, certificate of diagnosis or disability proof for recognition).

新雇主 New employer： （簽章Seal， 家庭類請簽名Please sign here if hire domestic helper）

原雇主Original employer： （簽章Seal，家庭類請簽名Please sign here if hire domestic helper）

外國人Foreigner： （簽名Signature）