Federal Ministry of Labour and Social Affairs MoLSA

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Information form for Ethiopians permitted to work abroad

Application Type New Renewal

Basic Data

Full name
A value is required.

Date of birth

Place of birth
A value is required.

Gender
Male Female

Marital status

Religion

Region

City/Town

Sub-city/Zone

Kebele

House number

Telephone

Fax

P. O. Box

Email
Invalid format.

Educational Data

Qualification type

Spefify if other

Level of qualification

Spefify if other

Year completed

Professional skill

Field of study

Award

Spefify if other

Emergency contact person

Full name
A value is required. A value is required.

Date of birth

Place of birth
A value is required.

Gender
Male Female

Region

City/Town

Sub-city/Zone

Kebele

House number

Telephone

Fax

P. O. Box

Email
Invalid format.

Employment Agency

Agency name
A value is required. A value is required.

Region

City/Town

Sub-city/Zone

Kebele

House number

Telephone

Fax

P. O. Box

Email
Invalid format.

General manager

Amount of deposit

Country(ies) of operation

Bahrain	Kuwait	Lebanon	Qatar	Saudi Arabia
Syria	UAE	Yemen	Other (Specify)

Investment permit or business license number

Private/Public employment agent data

Agent name
A value is required. A value is required.

Country
A value is required. A value is required.

City/Town
A value is required. A value is required.

Telephone
A value is required. A value is required.

Alternate Telephone
A value is required. A value is required.

Fax
A value is required. A value is required.

P. O. Box

A value is required. A value is required. Email
Invalid format.

Contact person
A value is required. A value is required.

ID/Passport Number
A value is required. A value is required.

Foreign Employer data

Family name
A value is required. A value is required.

Other name(s)
A value is required. A value is required.

Country
A value is required. A value is required.

City/Town
A value is required. A value is required.

Telephone
A value is required. A value is required.

Alternate Telephone
A value is required. A value is required.

Fax
A value is required. A value is required.

P. O. Box

A value is required. A value is required. Email
Invalid format. Invalid format.

ID/Passport Number of Employer

A value is required. A value is required.

A value is required. A value is required.

I hereby certify that this form was accomplished by me personally or under my personal direction, and all the information provided are correct.

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