`

APPLICATION FORM
Date: _______________

PERSONAL BACKGROUND:

Name _______________ _______________ ______________________ ____________________

Last Name First Name Middle Name Maiden (for married women)

Present address __________________________________________________________________________________

Number Street Barangay City Province

Age: ______________ Birthday:__________________ Birthplace:_______________ Nickname: ______________

Marital Status: _____________ Height : ___________ Weight : ____________ Gender: __________

Telephone/Cellphone# : _____________________ E-mail: _______________ Religion: ______________

SSS #_____________________________________ PAG-IBIG (HDMF) #: _______________________________

Philhealth (PHIC) # _________________________ TAX IDENTIFICATION NUMBER (TIN)______________________

EMPLOYMENT DESIRED:

When are you available to start work? __________

Position(s) applied for
__________________________________________
Salary Desired: ____________________________

FAMILY BACKGROUND:

NAME AGE / ADDRESS OCCUPATION COMPANY

Father

Mother

Spouse

SIBLING’S NAME AGE ADRESSS OCCUPATION COMPANY

 `

OCCUPATION/ COMPANY/
CHILDREN’S NAMES AGE ADDRESS
YEAR LEVEL SCHOOL

EDUCATIONAL BACKGROUND:

NUMBER OF
NAME OF YEAR
QUALIFICATION MAJOR & YEARS
SCHOOL & GRADUATE
D OBTAINED SPECIALISATION COMPLETE
LOCATION
D
Junior High
School
Senior High
School
College/
University
Graduate
Studies/Master
al

Doctorate

Skills

Talents

In case of emergency
Contact person: __________________ Relationship: ______________ Contact Number:_________________

WORK HISTORY:

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give
firm name. Attach additional sheets if necessary.
 `

Name of Employer _______________________ Position Employment dates Pay or salary

Address________________________________
_______________________________________
From Start
Phone number __________________________ To Final
Name of Last Supervisor:
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer _______________________ Position Employment dates Pay or salary

Address ________________________________
______________________________________

Phone number___________________________ From Start

To Final
Name of last supervisor
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer _______________________ Position Employment dates Pay or salary

Address ________________________________
________________________________________

Phone number___________________________ From Start

To Final
Name of last supervisor
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give
firm name. Attach additional sheets if necessary.

Name of Employer _______________________ Position Employment dates Pay or salary

Address________________________________
_______________________________________
From Start
Phone number __________________________ To Final
 `

Name of Last Supervisor:

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer _______________________ Position Employment dates Pay or salary

Address ________________________________
______________________________________

Phone number___________________________ From Start

To Final
Name of last supervisor
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer _______________________ Position Employment dates Pay or salary

Address ________________________________
________________________________________

Phone number___________________________ From Start

To Final
Name of last supervisor
Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Are you currently employed?  Yes  No

May we contact your present employer?  Yes  No
Did you complete this application yourself?  Yes  No
If not, who did? _________________________________________

Have you ever been charged of a civil / criminal case?  Yes  No

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s)
was/were committed, sentence(s) imposed, and type(s) of rehabilitation. ________________________________________
_______________________________________________________________________________________________________
 `

Have you ever been employed with this company?  Yes  No

If yes, when? ______________

Do you have any friends or relatives employed by this company?  Yes  No

If yes, please provide their names and relationship to you. ________________________________________

Why do you think you will be an asset to the company?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

APPLICATION FORM WAIVER – PLEASE READ CAREFULLY

In exchange for the consideration of my job application, I agree that:

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts
called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools,
previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result
of such contract.
I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after
employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is
based on the successful passing of testing under such policy.
I understand that, in connection with the routine processing of my employment application, the Company may request investigation
pertaining to my credit records, character, general reputation, personal characteristics, and mode of living
I further understand that my employment with the Company shall be probationary for a period of Six (6) months, and further that at
any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason
by either party.

Understood and Accepted by: ______________________________

Printed Name over signature

Date: _________________________