Online Preliminary Assessment Form
Please completely and appropriately fill out the form below. All fields marked with a * are required:
PART 1 PERSONAL DETAILS
Family Name*
Given Name*
Middle Name*
Gender*
Date of Birth * (DD-MM-YYYY)
Age*
Place of Birth *
Partnership Status*
Do you have a valid Philippine passport?* Yes No
If YES, What is your Passport Number?
Place of Issue
Date of Issue
Expiry Date (DD-MM-YYYY)
My residential address in my home country is:*
My Postal Address in my home country is (if different from residential address):*
What is your LANDLINE number?

What is your MOBILE number?
Email Address*
PART 2 QUALIFICATIONS
EDUCATION HISTORY (Please indicate Name and Address of School/Course Taken/Date of Graduation)*
Secondary (High School)*
Vocational or Trades (Indicate NA if not applicable)
Bachelor's (Tertiary)*
Post Graduate (Indicate NA if not applicable)
Profession*
PRC License Number (if applicable)
PRC License Expiry Date (MM-DD-YYYY)
Do you have a valid (less than 2 years) IELTS Test report?* Yes No
If YES, please select type of exam: Academic General
What are your scores? Reading: Writing: Listening: Speaking:
If NO, are you willing to take IELTS? Yes No
PART 3 EMPLOYMENT HISTORY (Please indicate your employment experience for the last 5 years. Use the format JOB TITLE/ DESCRIPTION/ EMPLOYER /INCLUSIVE DATES)
Employment History
(Start from Present Employer) *
How long have you practiced your profession?*
Places of Work*
If overseas, indicate country/ies:
PART 4 REFERENCES
Do you have friends,relatives, or contacts in New Zealand?* Yes No
If yes, please list them on the space provided. (Name/Relationship/Contact Numbers)
What is your purpose for filling up this assessment form?*
Do you have other information which may affect our assessment of the data which you have provided in this form?