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Background Check Request Form

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rodriguez.jamester17
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22 views

Background Check Request Form

Uploaded by

rodriguez.jamester17
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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BACKGROUND CHECK REQUEST FORM

Please fill out the fields legibly. Use the back sheet if necessary. All information will be treated with utmost confidentiality.

PERSONAL INFORMATION: Date: ___02/27/2024_____

Name of Candidate:
________Rodriguez__________________Jamester________________Jutcho____________

Last Name First Name Middle Name


Address:
Contact Numbers: 09927397653 Email Address: Birth Date: Sex:
(Landline & Mobile) [email protected] 08/17/1997 Female
NBI No.: SSS No.: TIN No.: Position Applied:
33543580 08-2723200 357272113-000 Treasury Assistant

CHARACTER REFERENCES: (Co-Worker & Immediate Superior)


Contact Numbers
Name Position Company Name & City Address (Must be active and contactable)

1. Lester Othelo Dejos Supervisor Accolade Resources, Inc 09666607681


2. Harlie Lim Team Leader Accolade Resources, Inc 09770058355

3. Lawrence Bautista Team Leader Accolade Resources, Inc 09758631668


4.

5.

EMPLOYMENT REFERENCES: (Make use of the Back Page for more Employment References)
Date of Employment Reason for Contact Numbers
Company Name & City Address Position (Start Date–End Date) Leaving (Must be active and contactable)

1. Jollibee Foods Corporation Service January 2017 – Continuing my


crew/cashier November 2017 study
2. Accolade Resources, Inc. Transcriptionist November 2019 – Relocation
May 2023
3.

4.

5.

SCHOOL RERFERENCES:
Name of School: Southern de Oro Philippines College
(College / Tertiary)
Complete Address: Julio Pacana Street, Cagayan de Oro, 9000 Misamis Oriental
Course: Bachelor of Science in Information Technology
(Vocational | Degree)
Date Graduated (Graduate) / 2019 - 2020
School Year Attended (Undergraduate)

Relative to R.A. 10173 or the Data Privacy Act of 2012, a policy that protect the fundamental human rights of
privacy. I hereby know and understand that as part of the Recruitment Process, I shall be subjected to a
background investigation commissioned by P.A. Alvarez Properties and Development Corporation. Hence, I hereby
authorize the company and or its authorized representative, Right-Check Philippines to confirm and verify my
employment including matters of conduct/behavior, ability/reputation, education, family, residence and
employment as well as my financial and credit standing. I also authorize and request each person and firm referred
in my Application Form to publish such information.

______Rodriguez, Jamester J __________


Signature over Printed Name
BACKGROUND CHECK REQUEST FORM

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