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eHomemakers’ Application for Telework
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.
Spouse of Malaysian Citizen
For Klang Valley, please specify locations:
Bandar Tun Razak
PJ New Town
PJ Old Town
Taman Tun Dr. Ismail
Others, please specify:
30 to 40
40 to 50
50 to 60
60 to 70
Number of children under 6
More than 4
Number of children between 7-12
Number of children between 13-18
Number of special children who
need special/constant care
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:
Academic & Professional Qualifications
Other professional training, please specify:
are earning income, what kind of work do you do?
Please check “Yes” or “No” for the
able to travel to an office every day?
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?
no, please explain your condition in extra space provided below
need special transport arrangement like a disabled friendly van?
sit for more than 3 hours straight?
able to read find print or computer screen without any difficulties?
need to use bifocals in order to read fine print, read computer screen text
or for typing?
able to use your hands for typing for more than 1.5 hours straight?
able to use your hands on detailed work (e.g. sewing) for more than 3 hours
able to focus on your job for more than 3 hours straight?
able to work in a social environment/mix with people comfortably?
have space at home for a desk?
does your desk at home have enough space for:
have a home computer?
have internet connection at home?
have VOIP or Skype?
Please list & describe any specific skills/knowledge/hobby
Please give more details
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
Please describe any volunteer
work (if any) that you do
How many hours per week can you work?
Fewer than 10
How many hours per day can you work?
Fewer than 3
Fewer than 5
Preferred Work Hours
Do you experience any of the following problems? (eHomemakers will try to get work from companies that practice CSR (corporate social responsibility)
Chronic illness that requires regular medical
Critical illness that requires periodic
Inability to concentrate
Inability to sit for more than two hours at a
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).
Starting with your present post, list in reverse order every employment you have had. If you need more space, please attach additional pages
Name of Employer
Reason(s) for leaving
Type of work
& description of duties (Eg:
administrative, data entry, marketing/ sales, clerical, inventory
Do you have experience in the following tasks?
If Yes, no.
months or years
phones, taking messages, directing calls
callers’ names, contacts and reason for calling into a computer spreadsheet?
customer care follow-up (e.g. follow up on caller requests, gather additional
information from customers, payments follow-up)?
emails and managing folders
company notes/ memos
administration – e.g. call for maintenance,
supplies, compile receipts, manage mail
of documents - e.g. folder filing, classifying and retrieving documents
and managing boss’ schedule - e.g. book transportation, arrange schedules and
responsibilities- pay bills, keep & track records, submit monthly
reports, simple calculations
with the following software
the web (finding out information from the internet)
Approximately how many minutes/hours do you take to type one A4 page, double-spaced?
Less than 10 minutes
10 - 15 minutes
15 - 30 minutes
30 - 45 minutes
45 - 60 minutes
More than 60 minutes
Please list languages and dialects that you know (Those who speak and write foreign languages are especially encouraged to apply.)
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