REC–EAFRM-01

EMPLOYMENT
APPLICATION FORM Revision Code: 00 Page 1 of 2
Effectivity Date: October 18, 2019

PHOTO

Date of Application: August 31, 2022 Position Applied For: Field Sales Agent

Source of Application: Online Ads Walk-in Referral Job Fair

Referred by: Chenie Ve S. Ferrater Company: PRIMUS

PERSONAL DATA
Name: Balonga Jay Nickname: Age: 23 Gender: Male
Jing Civil Status: Single Height: 174 cm
(Last Name) ( First Name) (Middle Name)
Current Address: Phase 5, Elrio Vista, Davao City
Years in Residence: 1 year
Provincial Address: Davao del Sur
Permanent Address: Barangay Libertad, Kaputian District, IGACOS
Date of Birth: August 29, 1999 Place of Birth: IGACOS
Mobile No: 09560885109 Religion: Christianity
Home Tel. No.: SSS No. 09-4410273-4 PhilHealth No. 16-025800809-7
Email Address: [email protected] TIN Pag-IBIG No. 121224398304
Nationality: FILIPINO No. of Dependents: 2
Person to Notify in case of Emergency: Mildred S. Cadenas Relationship: Auntie
Address: Phase 5, elrio Vista, Davao City Contact no.: 09650388701
FAMILY BACKGROUND
Name of Spouse: Occupation:
Father’s Name: Bobby S. Enotibas Occupation: Farmer
Mother’s Name: Merrypher B. Enotibas Occupation: Housewife
EDUCATIONAL BACKGROUND
Degree School Inclusive Dates & Year Course Taken / Strand
Post Graduate
College Christian Colleges of Southeast Asia August 27, 2022
Vocational
Senior High School Libertad National High School June 2018
EMPLOYMENT INFORMATION Last five (5) employers in descending order
Company Position/ Expertise Inclusive Dates & Year Reason for Leaving

Availability to start for work:

PENDING LOCAL APPLICATION(S) / OFFER(S) STATUS

SKILLS ASSESSMENT Please rate skills below, 10 being the highest and 1 being the lowest
Rank No. of Years Professional
Computer Proficiency Year of Last Significant Experience
(1 – 10) Experience
MS Word 7 2
MS Excel (pls. specify) 7 1
MS Powerpoint 7 2
MS Outlook 5 0
Adobe Products (pls. specify) 4 0
Accounting System (s) 5 0
PRE-EMPLOYMENT REQUIREMENTS
Please check if the following documents are available:
Original copy of the following: Photocopy of the following:
 Birth Certificate (NSO Copy)  SSS E-1 (single) or E-4 (married) Form / SSS ID / SSS
 NBI Clearance Verification Slip
 Police Clearance  Tax Identification Number ID / Previous 1902 Form / BIR
 Barangay Clearance TIN Verification Slip
 Pre-employment Medical Result (Basic Five: Physical  PhilHealth ID / MDR Form
Exam, Urinalysis, Fecalysis, CBC, Chest X-ray – Fit To  Pag-IBIG Loyalty Card / Online Registration form with
Work Result) MID number
 Drug test  Latest 2316 or BIR W-2 (from previous employer
 Certificate of Employment indicating correct tax status)
 Transcript of Records / Diploma  Marriage Certificate (if applicable)
 3 pcs. 1x1 colored picture (white background)

MEDICAL ASSESSMENT
MEDICAL CONDITION (Pls. check others if not in the list or not existing)
Hypertension /High Blood Pressure  Epilepsy/Seizure Disorder  Allergies (pls. specify: ____________________)
Diabetes Tuberculosis  Heart Illness Asthma  Others (pls. specify: _____________________)
SOCIAL BEHAVIOR
Smoking:  Yes  No If yes, how many sticks per day? ____ How long have you been smoking? ______
Liquor Drinker:  Yes  No Have you taken any prohibited/unregulated drugs?  Yes  No
CHARACTER REFERENCES
Employers/Supervisors Company Position Tel. or Mobile Number / E-mail Address
1.
2.
3.
Relatives/Friends Relationship Tel. or Mobile Number / E-mail Address
1. Jane B. Enotibas Sister [email protected]
2. Eric B. Sinining Brother 09099704249
3. Susan Ado Auntie 09197482723
REFERRALS
Name Contact Number / E-mail Position Title
1.
2.
3.
HOME ADDRESS SKETCH
Recruitment Privacy Notice:

Prime@ Technology Specialists, Inc. is committed to maintaining the personal data privacy of its candidates. We collect personal information such as full
name, birth date, email address, contact numbers, work history and other personal information which are relevant to the recruitment process. When you
send a resume or an application to us, the collected information is utilized solely for screening purposes which include interviews and reference checks
by our representatives and its clients. This Privacy Notice is provided specifically where it is posted.
JAY BALONGA
Signature Over Printed Name