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Deployment Form
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Deployment Form
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PNI INTERNATIONAL CORP. POEA-013-LB-011008-R UNIT 240 Strata 2000 Bldg. Emerald Ave. Ortigas Center Pasig City Tel No. (02) 631-5206/ Fax No. (02) 631-6001 CANDIDATES REQUIREMENTS Employer's Name: _S# Candidates Name: Position: Contact No.: Email Address: Skype ID: lowing requires ur compli Date Submitted: Received by: Resume Diploma Certificates Pictures (Passport Size) NBI Medical visa Passport OFC Flight Ticket Briefing Documents DEPLOYMENT FORMS: Date Submitted: Received by: ‘Agency Agreement Employment Contact tor Security Deposit Agreement Affidavit for Undertaking Phil health Form FW Forms Affidavit of Sworn Statement Candidates Registration Notice Referral for Medical Roferral for PDOS Airport Pick-up FormsAFFIDAVIT OF SWORN STATEMENT KNOWN ALL MEN BY THESE PRESENTS That, of legal age with residence address at o do by these presents swear that | will take full responsibility of my repatriation and whatever cost may occur in case I resign without due cause from my employer, |am homesick, | am not performing the task assigned to me, | violated labor law of my employer's country, | became pregnant or | got someone pregnant, | committed unjust actions, | participated in illegal union, | committed stealing or crime and the like in consideration whereof, | promise to take full responsibility of my actions in cases where | am opting to return to the Philippines due to reasons stated above or related to the above. Failure to do shall warrant PNI International and employee to file a case against me. EXECUTED ON Pasig City, By Name CIC No. Issued on at iin noeteeeee eer re eee eee WITNESSED BY: REPUBLIC OF THE PHILLIPINES _ ) )S.S. Before me a Notary Public for and In, personally appeared the fore Signed. Releaser knows to me and to me knows to be the same person who executed the foregoing, Release Walver and Quitciaim. Releaser exhibited to be the above Community Tax Certificate and acknowledge to me that the same is his true and voluntary act and deed. Doc No. NOTARY PUBLIC Page No. Book No. Series of,© POEA Licence No. POEA-366-D.030604.8 PAS ) UNIT 210 STRATA 2000 BLDG. EMERALD AVE. ORTIGAS CENTER PASIG CITY [vo ‘TELNOS. 631-5206/631-6001/FAX NO. 637-6125 AGENCY HIRED OFW ID FORM PERSONAL DATA Worker Name: a First name Middle Name Last Name x Birth Date: ciwtsiatus{) single () separated oO Married (Gan) Widowed Mother's Maiden Name: PHOTO/SIGNATURE Photo of OFW Signature of OFW {PLEASE SIGN WITH BLACK PEN WITHIN THE BOX) VERIFIED BY: PRINTED NAME/SIGNATURE ~ DATE VERIFIED FOR USE OF CARD PRODUCTION ONLY OFW ID# corKNOWN ALL MEN BY THESE PRESENTS: THIS AGREEMENT is made entered into by and between: PNI International Corporation, a corporation duly organized and existing under and by virtue of the laws of the Republic of the Philippines, with office address at Unit 210 2% floor, Strata 2000 Bidg., Emerald Avenue, Ortigas Center, Pasig City represented hereby by Its President, Ms. JAN KAY RAVANZO, and hereinafter referred to as the “PII” - and x Filipino, of legal age, and residing at hereinafter referred to as “APPLICANT” They shall collectively refer to as the Par s. WITNESSETH that: WHEREAS, PII is a recruitment agency with POEA License Number 013-L8-011008-R links to principal who are in need of qualified WHEREAS, as the APPLICANT desires to a of the services of PNI for placement in WHEREAS, the parties herein have agreed to come to into this agreement subject to certain terms and conditions; NOW, THEREFORE, for and in consideration of the above premises and mutual covenants herein unto agreed upon, the parties hereto agree as follows: ARTICLE 1 REPRESENTATIONS & WARRANTIES 1. PNIhereby warrants that itis duly licensed recruitment and placement agency that deals with principals in who desire to employ ____ from the Philippines who shall meet the professional standards mandated by the Government, as well is the qualification standards defined by the principals; 2. The Applicant hereby warrants that he/she is a skilled worker of good standing in the Philippines, and that she is willing to pursue and abide by the rules and regulations of the recruitment process set by PNI and made known to the Applicant beforehand, until he/she is finally deployed to a principal. 3. The Applicant further warrants that he/she has not applied with any other agency for the employment in nor does him/her have anycontract of employment with any Middle East principal or that he/she does not have any pending processing agreement for employment in the with any other agency. 4, PNI shall expedite the deployment of the applicant within the most ideal time frame, upon his/her submission of all credentialing documents and successful completion of all required exams/interviews, However, both parties understand the time frame for deployment is contingent on the processing schedule of the host country. ARTICLE 2 RESPONSIBILITIES OF PNI PNI shall fulfill ts obligation to place the applicant with principal by performing the following: 1. Orient the applicant on the recruitment and placement procedures of the Agency and its principals, visa processing, medical examinations that need to be successfully and order to secure employment i provide written materials for this purpose 2. Ifaccepted facilitate securing an employment contract at the a: ‘and assist the principal in initiating the filling of the applicant's working visa. 3. Process the necessary documents for deployment such as: Overseas Employment Certificate or Exit Clearance from Philippine Overseas Employment Administration {POEA); Visa stamping; referring the applicants to Pre-departure; Orientation Seminar (PDOS); and confirm/verify the airline booking of the applicant from the Pre-paid Ticket Advise given by the principal. Signature: a Right thumb mark: wARTICLE 3 RESPONSIBILITIES OF APPLICANT The Applicant shall fulfill its obligation to pursue and abide by the rules and regulations of the recruitment process until he/she is finally deployed to a Middle East principal, my accomplishing the following Submit to PNI the original copies of the following: 11.1 Valid Passport 1.2 Resume with work history and detailed job description 1.3 Passport sized pictures with and without name and white background 1.4 College diploma and transcript of records 1.5 Copy of Employment Certificate 1.6 NBI Clearance 1.7 Trade Test Result 1.8 Medical Results Attend the orientation seminars conducted by PNI on the recruitment and placement procedures of the Agency and its principals, and the documents needed ‘to be accomplished in order to secure employment among others. Cooperate fully and communicate constantly with the Deployment Administrator and Recruitment Officer who shall guide him/her in fulfilling all the necessary requirements for employment. ‘The candidate may seek advice from PNI Deployment Administrator of Recruitment Officer if he/she was not able to pay the direct deployment cost in due time Take the responsibilities for informing the deployment administrator for any changes in the applicants contact information, place of residence, civil status, local employment status or any other information relevant to his/her ongoing job. Perform all other duties and actions necessary in order to secure employment as a inthe f Signature: x Right thumb mark: »ARTICLE 4 PENALTIES PNI shall implement corresponding penalties should the applicant fail to fulfill his/her, obligations as follows: 1. Should the candidate withdraw acceptance of the employment given by the principal, the direct deployment cost of the POEA and Embassy will no longer be refundable. 2, Inthe event that the applicant withdraws his/her application after services has been. rendered by PNI, work visas & PTA’s are already purchased by the principals, the applicant is obligated to pay PNI the amount corresponding the services which has been rendered prior to the withdrawal of his/her application. PNI shall exercise a lien over the original documents in its possession and will turn over to the applicant documents only after the applicant's obligations have been paid in full, 3. In cases where the application has been duly processed and referred to a prospective or present principal by PNI, the applicant shall furthermore not be allowed to deal directly with the principal, or any other principal in the same country, without prior written consent of PNI, which shall be given upon payment of the appropriate fees to PNI. In case of violation of this provision, the applicant shall be liable to pay PNi liquidated damages in the amount equivalent to the search fee PML is charging the principal. ARTICLE 5 FEES 1. The costs and service fees of PNI for undertaking this recruitment and placement activity are generally paid by the foreign principal; therefore these services are rendered at no fees to the applicant except if an arrangement with the principal is, salary deduction on the candidates’ part or applicants are required to pay placement fees, In this event, candidate is required to pay a placement fee as a agreed with foreign principal. 2. Mobilization / Processing Fees (POEA, Embasey, Admin) however are chargeable to the applicants in the amount of 3. Sacurity deposit of Php. which chall bo RETURNED after completion of, employment contract with (Security deposit agreement annexed)ARTICLE 6 GOVERNING LAW ‘The parties agree to work together to settle amicably any dispute arising from this Agreement. However, failure to resolve the same shall be settled in accordance with the arbitration rules of the Philippines Dispute Resolution Center, Inc. and interpreted in accordance with the laws of the Republic of the Philippines. IN WITHNESS WHERE OF, the parties hereto have affixed their signatures on day of Signature: x Right thumb mark: »TASTEST PAYMENT ‘DO NOT WRITE ON THIS SPACE, parte (Ger OEA, OWWA, Phat Une On) Miwon kr: PHILIPPINE OVERSEAS EMPLOYMENT ADMINISTRATION | Asesmen Ne ater OVERSEAS WORKERS WELFARE ADMINISTRATION | Atul Ansan: THILIPINE HEALTH INSURANCE CORPORATION | POA, prea FULPOEA 02-68-07 Eflecvty date Apri 8, 2005 OFW INFORMATION SHEET PERSONAL DATA. ‘Change/s (if anv) Name _% Name (apy Fini Name (Pane) ‘Wile Nae 16 sia) ‘Adres in the Phils Tran ith dates ee OMO® conten Ota Otten i wi DD TAY TD startet TO separates Pasepore er Might Edcatonal Atanment Name of Spouse Wimarie Mother's Fall Males Name ‘Legal Beneficiaries (Mga tatanggap ng benepsye sa OWWA): ‘Name Relaionsp Adress ‘Name of Principal / Company / Employer Adres fe ‘bse’ Caany of Desiaation ms TaNe: Poston of OFW: Fax No? Email adres (Contact Duration ‘none Monty Say ast dite of arival of vacationing worker in the Phils: Date of schedule depart Retar of OFW to the obes Name of Ageney (i apie: Corea Tiga of Woke Approval of a “Thurnbrack Representative (ifageneyired) (To be filled in by OFW— for PHILHEALTH RECORD) Name of Worker Family Name pavBoy Fist Ware Pagal) idl Nase ©. Apslyidoy Ars in he Pippi Taha) Z Tene Date Bh er ‘Binplae poe sx OM OF Mi Se D Single CO Married =] Widowed =] Separated Dependents (Mga makikinabang) 20 yu old an below or ile, 6 years ol an above for pret, nd Unemplayed spss, sav Relaonship of FW. Die of Bich te depends (mvt) Thrace sve ann ee wn core Aa aS an Han a a TR ‘ignatare of WorkerHap PFF.
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