Title Page
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Company Name
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Document No.
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Employee ID
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Location
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Conducted on
Information
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Employee no.:
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Profile:<br>A: SC or PR who are non-PME with basic monthly salary NOT exceeding $2,500<br>B: SC/PR who are Workman with basic monthly salary not exceeding $4.500<br>C: Work Permit Holders
Profile
Employee's Profile
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Are you the company's director / owner?
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Are you related to the company's director/owner?
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Please specify your relationship
Employee Details
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Employee Name
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NRIC / FIN
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Nationality
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Please Specify
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Residential Status
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Please Specify
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Employment Start Date
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Contact No.
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Occupation
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Industry
- Cleaning
- CLSP
- F&B
- Landscape
- Logistics
- Retail
- Security
- Others: Education
- Others: Real Estate
- Others: Transport
- Others: Wholesale
- Others
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Please Specify
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Place of Work
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Supervisor's Name
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Supervisor's Contact No.
A. Salary
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1. How often are you paid your salary? (State the date or day of payment)
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Enter Date
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Enter Date OR
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Enter Day
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Enter Date OR
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Enter Day
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Enter Date OR
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Enter Day
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Enter Date OR
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Enter Day
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2. When were you paid your latest salary?
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Remarks/Assessment
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3. Did you receive a pay slip (hard or softcopy) for your salary?
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Non-provision of pay slip
Basic Salary
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4. What is your monthly gross salary?
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Monthly/Daily/Hourly
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What is your monthly basic salary?
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Are there component(s) in your monthly salary, excluding basic salary? A for fixed allowance and R for reimbursements
- Overtime
- Transport
- Attendance
- Housing
- Mobile phone
- Meal
- Laundry
- Others
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Overtime ($)
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Allowance
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Reimbursement
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Transport ($)
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Allowance
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Reimbursement
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Attendance ($)
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Allowance
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Reimbursement
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Housing ($)
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Allowance
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Reimbursement
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Mobile phone ($)
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Allowance
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Reimbursement
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Meal ($)
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Allowance
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Reimbursement
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Laundry ($)
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Allowance
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Reimbursement
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Please Specify
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Others ($)
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Allowance
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Reimbursement
CPF
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5. Does your employer pay CPF for you every month?
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Reason?
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Reason?
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6. Is CPF paid for your allowance(s)?
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Reason?
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Do you have to submit receipt to support these allowance(s)?
Remarks / Assessment
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Non-payment of CPF contribution
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Underpayment of CPF contribution due to CPF not paid for;
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Component 1
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Component 2
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Component 3
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Component 4
Salary
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Were there instances where your current employer paid you less salary than you were supposed to receive?
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Please state amount owed
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Period of occurences
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Reason(s) given by employer
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Did your employer pay you back the amount owed?
Sign Off
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Interviewee Signature
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Inspector Signature