Home ManagersInformation Form SECTION 1: Personal Information Full Name Date of Birth Phone number National ID / LC Letter / Referral ID (Upload or type number) Religion Tribe Nationality SECTION 2: Origin & Residence District of Origin Village / Subcounty / Parish Do you have relatives in Kampala? YesNo If yes, share their name & contact SECTION 3: Emergency Contact Next of Kin Phone Number Email (if any) Home Address Dependants (if any) Number: Age Range Gender(s) Guardian's Contact (if not the applicant) SECTION 4: Health & Status Are you pregnant? YesNo What is your HIV/Hepatitis B status? PositiveNegative SECTION 5: Education & Skills Education Level Completed NonePrimaryO-LevelA-LevelVocationalUniversity What are you good at? (Select all that apply) CleaningCookingLaundryChildcare / NannyElderly careGardeningSecurityElectronics / Appliance UseOther: What are your dislikes or things you don't want to do? SECTION 6: Work Experience Previous Jobs (if any) Where? How long? Size of family? Children’s age(s)? Why did you leave? Why do you want to work with Bezalelz? How long would you like to work? Short-term (under 6 months)Long-term (6+ months)Indefinitely Salary Expectation (Minimum UGX 200,000): SECTION 7: Discovery & Feedback How did you hear about Bezalelz? FriendSocial MediaChurch / SchoolOther If someone referred you, please include their name & contact. Any comments or suggestions?
