APPLICANT’S DATA SHEET

I. PERSONAL INFORMATION
POSITION APPLIED FOR HOW DID YOU COME TO KNOW OF THE POSITION E-MAIL
1. 2.
FAMILY NAME FIRST NAME MIDDLE NAME NICKNAME BIRTH ORDER

PRESENT ADDRESS ZIP CODE LIVING WITH CELLPHONE NO.

PERMANENT ADDRESS ZIP CODE LIVING WITH TELEPHONE NO.

PROVINCIAL ADDRESS IS YOUR RESIDENCE IN A HIGH-RISK AREA FOR NATURAL CALAMITIES?

FLOOD PRONE EARTHQUAKE OTHERS_______________________
PERSONAL DATA

DATE OF BIRTH PLACE OF BIRTH CITIZENSHIP BLOOD TYPE SEX

RELIGION CIVIL STATUS DATE OF MARRIAGE HEIGHT WEIGHT

PHILHEALTH NO. PAG-IBIG NO. TIN SSS NO.

FATHER’S NAME OCCUPATION/EMPLOYER MOTHER’S MAIDEN NAME OCCUPATION/EMPLOYER

NAME OF SPOUSE DATE OF BIRTH (SPOUSE) OCCUPATION/EMPLOYER

NAME OF YOUR CHILDREN DATE OF BIRTH NAME OF YOUR CHILDREN DATE OF BIRTH
1) 4)

2) 5)

3) 6)
PERSON TO CONTACT NAME ADDRESS TELEPHONE NO. RELATIONSHIP
IN CASE OF EMERGENCY:

TYPE OF HIGHEST LEVEL

NAME OF SCHOOL COURSE FROM TO
SCHOOL COMPLETED

ELEMENTARY
EDUCATION

HIGH SCHOOL

VOCATIONAL
SCHOOL

COLLEGE

POST
GRADUATE

NATURE OR TITLE OF SEMINAR, WORKSHOP,

TRAININGS

NAME AND LOCATION OF INSTITUTION INCLUSIVE DATES ATTENDED

SPECIAL COURSE, OR SCHOLARSHIP
 SPECIAL SKILLS/ OTHER QUALIFICATIONS YES NO SPECIAL SKILLS / OTHER QUALIFICATIONS YES NO
COMPUTER SKILLS (SPECIFY SOFTWARE) LABORATORY WORK

COMPUTER REPAIR/ MAINTENANCE DRIVING (Specify type of license)

SKILLS

ACCOUNTING SKILLED WORK: (Pls. specify)

(e.g., electrical, carpentry, painting, plumbing, welding,
automotive, mason )
CASHIERING (PRC) PROFESSIONAL ELIGIBILITY: LICENSE NO:

OTHERS: (Pls. specify) REGISTRATION DATE: VALIDITY:

MEMBERSHIP IN ORGANIZATIONS AND CLUBS

ACTIVITIES

HOBBIES & RECREATIONAL ACTIVITIES

( (Employment record outside the BANK. Please start with the most recent)
INCLUSIVE DATES OF
COMPANY NAME & ADDRESS POSITION SALARY REASON FOR LEAVING
EMPLOYMENT
WORK EXPERIENCE

(Employment record in the Bangko Pangasinan – A Rural Bank, INC.. Please start with the most recent)
INCLUSIVE DATES OF
UNIT POSITION SALARY REASON FOR LEAVING
EMPLOYMENT

REFERENCES: (EXCLUDE RELATIVES)

REFERENCES

NAME NAME AND ADDRESS OF COMPANY POSITION TEL NUMBER

1.

2.

3.
 DO YOU HAVE ANY CIRCUMSTANCE/CONSIDERATIONS THAT MIGHT AFFECT YOUR EMPLOYMENT IN THE BANK IF HIRED (E.G plans of migrating,
further studies, and health?) ____ YES ____ NO If yes, please give details:

HAVE YOU EVER BEEN SUBJECTED TO ANY DISCIPLINARY ACTION IN ANY OF YOUR PREVIOUS EMPLOYMENT? ____ YES ____ NO
If yes, please give details:

MAY WE CONTACT YOUR PRESENT EMPLOYER FOR REFERENCE: ___ YES ___ NOT YET ___ NO
IF YES/NOT YET, WHEN IF NO, STATE YOUR REASON
HEALTH

DETAILS YES NO IF YES, NATURE OF ILLNESS

PREVIOUS HOSPITALIZATION

PREVIOUS OPERATION

CURRENTLY UNDERGOING TREATMENT

DATE LAST CHEST X-RAY TAKEN RESULTS STATUS OF HEALTH (please check one)
□ EXCELLENT □ GOOD □ POOR

II. DECLARATION OF OCCUPATION AND EMPLOYER OF RELATIVES WORKING IN AND OUT OF THE
BANK

Print clearly and provide details according to this order: Parents, Siblings, Spouse, Children, Parent-in-law, Brother/Sister-in-law, First
Cousin-in-law, Uncle/Aunt, Nephew/Niece (son/daughter of brother/sister)

LAST NAME FIRST NAME MIDDLE NAME RELATIOSHIP OCCUPATION/EMPLOYER

OTHERS

I hereby certify that the foregoing information contained in this Applicants Data Sheet, consisting of four (4) pages, is true and correct
to the best of my knowledge and may serve as the basis of my employment and that I have not withheld any fact or circumstance which
could affect my application unfavorably. It is understood that if there are any omissions or misrepresentations contained in this
document, reasonable proof of this will be sufficient ground for the termination of my employment. This also serves as an
authorization to validate/check the details and any other information deemed necessary which I have provided in connection with my
application.

___________________________________________________ ___________
Applicant’s signature over printed name Date
III. AUTHORIZATION FOR VERIFICATION OF INFORMATION PROVIDED

Date: _______________________

This is to authorize the Bangko Pangasinan – A Rural Bank, INC. to verify all information I provided on my
Applicants’s Data Sheet and other submitted documents such as:
Resume
Official Transcript of Records
Diploma
Certificate of Employment/Good moral
Medical Records
NBI Clearance
NSO Birth Certificate (applicant/dependents)
NSO Marriage Contract
Others:
______________________________________________________________________

________________________________________________
Applicant’s signature over printed name

IV. ESSAY
Name: Date:
1. Describe yourself.

2. What are your strengths and weaknesses? Please explain.

3. Why do you want to work at the Bangko Pangasinan – A Rural Bank, INC.?
NAME OF APPLICANT

_________________________ _________________________ _________________________

First Name Middle Name Last Name

Date of Exam: ___________________________ Time Start from: _________ To: ____________

ESSAY:
Time: 20 minutes

1. Give three words that best describe yourself.

a. __________________ b. _____________________ c. ________________________

2. What is your strength? What is your weakness?

3. Tell us about yourself that is not written in your resume.

4. How do you see yourself 5 years from now?