Edited Domestic absence from work form - 1

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اﺳﺘﻤﺎرة إﺧﻄﺎر ﺗﺮك اﻟﻌﻤﻞ ﺑﺎﻟﻤﺨﺎﻟﻔﺔ ﻟﺸﺮوط اﻟﺘﺼﺮﻳﺢ ﻟﺨﺪم اﻟﻤﻨﺎزل وﻣﻦ ﻓﻲ ﺣﻜﻤﻬﻢ ﺑﻴﺎﻧﺎت ﺻﺎﺣﺐ اﻟﻌﻤﻞ اﺳﻢ ﺻﺎﺣﺐ اﻟﻌﻤﻞ رﻗﻢ ﺑﻄﺎﻗﺔ اﻟﻬﻮﻳﺔ ﺑﻴﺎﻧﺎت اﻟﻌﺎﻣﻞDomestic Employee Absence from Work form in Violation of the Terms Employer Name Personal Number Employer Details Expatriate's Details Data Provided by Employer 1. Where is the Expatriate’s passport currently? Yes 2. Are there any disputes between the Domestic Employee and his Employer? No - - اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﻘﺪﻣﺔ ﻣﻦ ﻗﺒﻞ ﺻﺎﺣﺐ اﻟﻌﻤﻞ؟. أﻳﻦ ﻳﻮﺟﺪ ﺟﻮاز ﺳﻔﺮ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ ﺣﺎﻟﻴ١ . ﻫﻞ ﺗﻮﺟﺪ ﺧﻼﻓﺎت ﺑﻴﻦ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ و ﺻﺎﺣﺐ اﻟﻌﻤﻞ؟٢ . ﺗﺎرﻳﺦ اﺧﺮ راﺗﺐ ﺗﻢ ﺳﺪاده ﻟﻠﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ٥ ﺟﻮر ﻟﻠﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ؟. ﻫﻞ ﺗﻢ ﺗﺴﺪﻳﺪ ﻛﺎﻓﺔ ا٦ ﺟﻮر اﻟﻤﺘﺨﻠﻒ ﻋﻦ ﺳﺪادﻫﺎ أن وﺟﺪ. ﻋﺪد ا٧ ؟(ﺛﻼﺛﺔ ﺷﻬﻮر) . ﻫﻞ اﺗﻢ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ اﻟﻤﺪة اﻟﺘﺠﺮﻳﺒﻴﺔ٩ . ﻫﻞ ﻳﻮﺟﺪ ﺑﻼغ ﻣﻘﺪم ﻓﻲ ﻣﺮﻛﺰ اﻟﺸﺮﻃﺔ ؟٤ . ﻫﻞ ﻃﻠﺐ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ اﻟﺮﺟﻮع ﻟﻤﻜﺘﺐ اﻻﺳﺘﻘﺪام؟١٠ . ﻫﻞ ﻃﻠﺐ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ اﻟﺴﻔﺮ اﻟﻰ ﺑﻼده؟١١ . ﻣﺎﻫﻮ ﻃﺒﻴﻌﺔ اﻟﺨﻼف ان وﺟﺪ٣ . ﻫﻞ ﻳﻮﺟﺪ ﻛﺸﻒ ﺑﺎﺳﺘﻼم اﻟﺮواﺗﺐ؟٨ ﻧﻌﻢ ﻻ3. What is the nature of the dispute ( if any )? 4. Did you file a report at the police station? 5. Date of last paid wage of the Domestic Employee 6. Have all the wages of the Domestic employee been paid? 7. Number of unpaid wages ( if any ) 8. Do you have a payroll receipt ? 9. Did the domestic employee finish his probation period ( three months )? 10. Did the domestic employee ask to go back to the manpower employment office ? 11. Did the domestic employee ask to go back to his country? Yes No ﻧﻌﻢ ﻻYes No ﻧﻌﻢ ﻻYes No ﻧﻌﻢ ﻻYes No ﻧﻌﻢ ﻻYes No ﻧﻌﻢ ﻻYes No ﻧﻌﻢ ﻻAuthorization Details I the undersigned have delegated Mr. / Mrs. On my behalf to complete all the required processes in accordance to the rule and procedures in the Labour Market Regulatory Authority (LMRA), and I will be responsible for all the legal consequences of this authorization. Employment Office CR NO. His / Her Personal Number - أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه ﻗﺪ ﻓﻮﺿﺖ اﻟﺴﻴﺪ/ اﻟﺴﻴﺪه رﻗﻤﻪ اﻟﺸﺨﺼﻲ رﻗﻢ اﻟﺴﺠﻞ اﻟﺘﺠﺎري ﻟﻤﻜﺘﺐ اﻟﺘﻮﻇﻴﻒﺗﻤﺎم إﺟﺮاءات ﺗﻘﺪﻳﻢ ﻫﺬا وذﻟﻚ ﻧﻴﺎﺑﺔ ﻋﻨﻲ أﻣﺎم ﻫﻴﺌﺔ ﺗﻨﻈﻴﻢ ﺳﻮق اﻟﻌﻤﻞﺛﺎر اﻟﻘﺎﻧﻮﻧﻴـﺔ اﻟﻤﺘﺮﺗﺒﺔ ﻋﻠﻰ ﻫـﺬا اﻟﺘﻔﻮﻳﺾ و اﻟﻄﻠـﺐ ﻣـﻊ ﺗﺤﻤﻠـﻲ ﻛﺎﻓﺔ ا اﻟﻤﺴـﺆوﻟﻴﺔ اﻟﻘﺎﻧﻮﻧﻴﺔ أﻣﺎم ﻫﻴﺌﺔ ﺗﻨﻈﻴﻢ ﺳﻮق اﻟﻌﻤﻞ. ﻣﻌﻠﻮﻣﺎت اﻟﺘﻔﻮﻳﺾVersion 1-2021 of The Work Permit اﻟﺮاﺗﺐ اﺳﻢ اﻟﻌﺎﻣﻞ رﻗﻢ ﺑﻄﺎﻗﺔ اﻟﻬﻮﻳﺔ اﻟﺠﻨﺴﻴﺔ أﺳﺒﺎب ﺗﺮك اﻟﻌﻤﻞ ذﻛﺮ اﻟﺠﻨﺲ أﻧﺜﻰ رﻗﻢ ﺟﻮاز اﻟﺴﻔﺮ- - - - Expatriate Name Personal number Nationality Passport Number Gender Male Female Occupation Salary Reasons for Absence from work اﻟﻤﻬﻨﺔ ﺗﺎرﻳﺦ ﺗﺮك اﻟﻌﻤﻞDate the Expatriate Left Work ﺗﺎرﻳﺦ اﻧﺘﻬﺎء اﻹﻗﺎﻣﺔResident Permit Expiry Date إﻗﺮار ﻣﻘﺪم اﻟﺒﻼغ أﻗﺮ ﺑﺄن ﺟﻤﻴﻊ اﻟﺒﻴﺎﻧﺎت اﻟﻮاردة أﻋﻼه ﺻﺤﻴﺤﺔ وﻋﻠﻰ ﻣﺴﺌﻮﻟﻴﺘﻲ اﻟﺸﺨﺼﻴﺔ. أﻗﺮ ﺑﺄن اﻟﻌﺎﻣﻞ ﺗﺮك اﻟﻌﻤﻞ ﺑﺎﻟﻤﺨﺎﻟﻔﺔ ﻟﺸﺮوط اﻟﺘﺼﺮﻳﺢ. اﺳﻢ ﻣﻘﺪم اﻟﺒﻼغ رﻗﻢ ﺑﻄﺎﻗﺔ اﻟﻬﻮﻳﺔ ﺗﻮﻗﻴﻊ ﺻﺎﺣﺐ اﻟﻌﻤﻞApplicant's Declaration I hereby declare that all the above data is correct and I shall be held personally responsible. Applicant's Declaration Name Personal Number Applicant's Relation to the Employer Contact Number Applicant's Signature Employer's signature I declare that the Expatriate is Absent from work in violation of the work permit terms. ﺗﻮﻗﻴﻊ ﻣﻘﺪم اﻟﺒﻼغ رﻗﻢ اﻟﻬﺎﺗﻒ ﺻﻔﺘﻪﺳﺘﻌﻤﺎل اﻟﺮﺳﻤﻲ ﻓﻘﻂ ﻟ- - For official use only Date Signature اﻟﺘﺎرﻳﺦ اﻟﺘﻮﻗﻴﻊﻢ اﻟﻄﻠﺐ ﻣﻦ ﻗﺒﻞ ﺗﻢ ﺗﺴﻠReceived By

Transcript of Edited Domestic absence from work form - 1

Page 1: Edited Domestic absence from work form - 1

استمارة إخطار ترك العمل بالمخالفة لشروط التصريح لخدم المنازل ومن في حكمهم

بيانات صاحب العملرقم بطاقة الهويةاسم صاحب العمل

بيانات العامل

Domestic Employee Absence from Work form in Violation of the Terms

Employer NamePersonal NumberEmployer Details

Expatriate's Details

Data Provided by Employer

1. Where is the Expatriate’s passport currently?

Yes2. Are there any disputes between the Domestic Employee and his Employer? No

- -

المعلومات المقدمة من قبل صاحب العمل

١. أين يوجد جواز سفر العامل المنزلي حالي�؟

٢. هل توجد خلافات بين العامل المنزلي و صاحب العمل؟

٥. تاريخ اخر راتب تم سداده للعامل المنزلي

٦. هل تم تسديد كافة ا�جور للعامل المنزلي؟

٧. عدد ا�جور المتخلف عن سدادها أن وجد

٩. هل اتم العامل المنزلي المدة التجريبية (ثلاثة شهور)؟

٤. هل يوجد بلاغ مقدم في مركز الشرطة ؟

١٠. هل طلب العامل المنزلي الرجوع لمكتب الاستقدام؟

١١. هل طلب العامل المنزلي السفر الى بلاده؟

٣. ماهو طبيعة الخلاف ان وجد

٨. هل يوجد كشف باستلام الرواتب؟

لانعم

3. What is the nature of the dispute ( if any )?

4. Did you �le a report at the police station?

5. Date of last paid wage of the Domestic Employee

6. Have all the wages of the Domestic employee been paid?

7. Number of unpaid wages ( if any )

8. Do you have a payroll receipt ?

9. Did the domestic employee �nish his probation period ( three months )?

10. Did the domestic employee ask to go back to the manpower employment o�ce ?

11. Did the domestic employee ask to go back to his country?

YesNoلانعم

YesNoلانعم

YesNoلانعم

YesNoلانعم

YesNoلانعم

YesNoلانعم

Authorization DetailsI the undersigned have delegated Mr. / Mrs.

On my behalf to complete all the required processes in accordance to the rule and procedures in the Labour Market Regulatory Authority (LMRA), and I will be responsible for all the legal consequences of this authorization.

Employment O�ce CR NO.

His / Her Personal Number

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رقمه الشخصيأنا الموقع أدناه قد فوضت السيد/ السيده

رقم السجل التجاري لمكتب التوظيف

وذلك نيابة عني أمام هيئة تنظيم سوق العمل ³تمام إجراءات تقديم هذا الطلــب مــع تحملــي كافة ا«ثار القانونيــة المترتبة على هــذا التفويض و

المســؤولية القانونية أمام هيئة تنظيم سوق العمل.

معلومات التفويض

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of The Work Permit

الراتب

رقم بطاقة الهويةاسم العامل

الجنسية

أسباب ترك العمل

ذكرالجنس

أنثىرقم جواز السفر

- -

- -

Expatriate NamePersonal number

NationalityPassport NumberGender

MaleFemale

OccupationSalary

Reasons for Absence from work

المهنة تاريخ ترك العملDate the Expatriate Left Work

تاريخ انتهاء الإقامةResident Permit Expiry Date

إقرار مقدم البلاغأقر بأن جميع البيانات الواردة أعلاه صحيحة وعلى مسئوليتي الشخصية.

أقر بأن العامل ترك العمل بالمخالفة لشروط التصريح.

رقم بطاقة الهويةاسم مقدم البلاغ

توقيع صاحب العمل

Applicant's Declaration

I hereby declare that all the above data is correct and I shall be held personally responsible.

Applicant's Declaration Name Personal Number

Applicant's Relation to the Employer Contact NumberApplicant's Signature

Employer's signature

I declare that the Expatriate is Absent from work in violation of the work permit terms.

توقيع مقدم البلاغ رقم الهاتف صفته

ل�ستعمال الرسمي فقط

- -

For o�cial use only

Date Signatureالتاريخ التوقيع Received Byتم تسل�م الطلب من قبل

Page 2: Edited Domestic absence from work form - 1

المستندات المطلوبة

لايتم قبول تقديم الطلب إلا في حالة استيفاء المستندات المطلوبة.

Required Documents

The Request will not be received unless all required documents are provided.

1. Domestic Employee Absence From Work Form containing all the details signed by the employer .2. Copy of the domestic employee's smart card ( if any ).3. Copy of the domestic employee's passport .4. Copy of the employer's smart card .5. Copy of Applicant's smart card if representing the employer.

١. الاستمارة الخاصة با�خطار مستوفية جميع البيانات، وموقعة من صاحب العمل فقط.٢. نسخة من بطاقة الهوية للعامل (إن وجد).

٣. نسخة من جواز سفر العامل.٤. نسخة من بطاقة الهوية لصاحب العمل.

٥. نسخة من بطاقة الهوية لمقدم الطلب في حالة ا�نابة.

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