Labor Human Rights Center/The Association For Migrant Worker'S Human Rights
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1) 상담폼을 모두 체워주시고 모르는 부분은 "모름" 이라고 써주세요.
2) 상담폼이 부족한 경우 맨 아래에 있는 "사건경위"에 써주세요.
Name in Passport
   
Used Name in Company
  
Nationality
   
Male/Female
Available Phone No.
  
  *etc) 010-5555-5555
Emergency (friend's) Phone No.
  
  *Include friend's name
Date of birth
   
  *etc) 1975/12/05
Date of Entrance to Korea
   
  *etc) 1999/12/12
Length of stay in Korea
Name of the Company
  
  *etc) 1997/4/5~1999/5/6, 2000/5/3~ present
  
Qualification of Stay

Legal
(합법)

    산업연수생(D3)
   연수취업(E8)
   고용허가제(E9)
   방문동거(F-1-4)
  기타
Illegal
(비합법)
연수취업(E8)
고용허가제(E9)
방문동거(F-1-4)
  기타
Company Phone No.
   
Company Address
   
Name of the Company Represen-
tative
  
Represen-
tative Phone No
   
Company Product
   
Job at the Company
   
  *What was your job at the company?
Work period
  
  *예) 2000/4/5~2005/5/6, 2005/8/3~ present
Working hours
  
  *예) 주간8:00~17:00 야간19:00~3:00
Monthly Salary
Pay-day
   Won(원)
  
Is the company still operating?




No. of Workers
present
Korean Worker 
Migrant Worker 
the time accident was happen
Korean Worker   
Migrant Worker   
Date of Accident
  
  *산재만 입력 etc) 2000/4/5 PM5시경
Injured Part of the Body
  
  *etc) hand, foot, finger
Attention Hospital
   
Hospital Phone No.
  
Evidence
   월급봉투    계약서   기타
  *가지고 있는 자료를 모두 선택해주세요. 기타를 체크하셨으면 써주세요.
Undergone process of Accident
   
  *사건경위와 하고싶은 말을 써주세요.
        
 
 
 

2nd Floor, 59-3 Namyoung-Dong,
Yongsan-gu, Seoul, 140-160, Korea
TEL : (02)749-6052/8975     FAX : (02)749-6055

 * No collect e-mail without notice  
 
Labor Human Rights Center / The Association for Migrant Workers' Human Rights