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Employer/Owner Work Permit Registration Form All required fields are marked with an asterisk (*)

A. Detail Information As In Passport

First Name *

NLN (No Last Name)

Middle Name

Last Name *

Gender *

Date of Birth *

Height *

Nationality *

Country of Origin *

Passport No *

Issued At *

Passport Issued Date *

Passport Expired Date *

Passport File *

(Image or PDF file not over 1MB.)

B. Detail Information As In Visa

Visa Part

Visa Type *

Visa No *

Visa Issue At *

Visa Issue Date *

Visa Expiry Date *

Visa Entry Date *

Visa Remark

Visa and Arrival Immigration Stamp *

(Image or PDF file not over 1MB.)

Stay Permit Part

Stay Permit Type *

Stay Permit No

Stay Permit Issue At

Stay Pemit Issue Date

Stay Permit Expiry Date

Stay Permit Remark

Stay Permit (If any)

(Image or PDF file not over 1MB.)

C. Business and Education

Business Name *

Main Business Activity *

Specific Business Activity *

Specific Business Activity Detail *

Start Business Date *

Business Address *

Position Categories *

Position *

Education Background *

Patent Tax *

(Image or PDF file not over 1MB.)

D. Physical Aptitude Certificate

Issued At *

Name of Other Clinic / Hospital *

Physical Aptitude Certificate *

(Image or PDF file not over 1MB.)

E. Contact

Mobile Phone *

Ex.Cambodia - 855

Ex.12XXXXXX

Other Phone

Ex.Cambodia - 855

Ex.12XXXXXX

Current Address *

E-mail *

Confirm Email *

Password *

Confirm Password *

Photo size 4cm width and 6cm height (Taken in last 6 months) *

(Image file not over 1MB.)

Residence Certificate issued by competent authority *

(Image or PDF file not over 1MB.)

I hereby declare that the information in this application and any attachments is true and completed. Providing false or misleading information may result in the Ministry of Labour and Vocational Training taking action to strike the applicant off the enrollment and to be faced with the law.

Duplicated Foreign Worker

Error

Warning

Passport File

Visa and Arrival Immigration Stamp

Last Exit Camdodia Date Immigration Stamp

Stay Permit (If any)

Certificate/Permit approving the business activity issued by competent authority

Patent Tax

Physical Aptitude Certificate

Photo size 4cm width and 6cm height (Taken in last 6 months)

Residence Certificate issued by competent authority

Request Over 1 Year Approved Letter