DOE-AS-HRMD-QF-R01

Date Issued: 15 Sept 2018

Rev No. / Rev. Date:

DEPARTMENT OF ENERGY
Energy Center, Rizal Drive, Bonifacio Global City
1632 Taguig City, Philippines

CONTROL #: _________________

APPLICATION FOR EMPLOYMENT

Source : Website Walk-in Jobfair Referral :

Position Applied For :

Please attach recent
1st 2nd
ID picture
Choice Choice Salary Desired :
3.5 cm x 4.5 cm
(passport size)

(Surname) (First Name) (Middle Name) (Name Extension) (Nickname)

Present Address
(No.) (Street) (Village/Town) (City) (Postal Code)

Provincial Address
(No.) (Street) (Village/Town) (City) (Postal Code)

Contact Numbers
(Telephone Number) (Cellphone Number) (E-Mail Address)

Age Birthdate Birthplace Sex Height Weight

(mm/dd/yyyy)

SSS No. Pag-ibig No. TIN

GSIS No. Philhealth No. Religion
Civil Status Single Married Annulled Separated Widowed
Pls Check One Staying at own house Renting Staying with Relatives
Languages / Dialects Spoken
Interests / Hobbies / Past time
Other Special Skills / Can operate or use (machines/eqpt/software)
Other special qualifications, books published, article written
Are you willing to be assigned in the province? Yes No If yes, indicate what preferred location

EDUCATION
Name & Address of School Attended Course / Degree / Major Inclusive Date of Attendance Honors/Distinction Received
Elementary
Secondary
Vocational
College
Post Graduate
Study / Scholarship Grant

EMPLOYMENT HISTORY
(Start with your present or latest job)

A. Company Nature of Business

Address / Tel. # Immediate Superior
Employment Date: From (mm/dd/yyyy) To (mm/dd/yyyy)
Position at Start Position at Leaving
Status of Appointment Monthly Salary
Job Description

Reason for Leaving

B. Company Nature of Business

Address / Tel. # Immediate Superior
Employment Date: From (mm/dd/yyyy) To (mm/dd/yyyy)
Position at Start Position at Leaving
Status of Appointment Monthly Salary
Job Description

Reason for Leaving

C. Company Nature of Business

Address / Tel. # Immediate Superior
Employment Date: From (mm/dd/yyyy) To (mm/dd/yyyy)
Position at Start Position at Leaving
Status of Appointment Monthly Salary
Job Description

Reason for Leaving

If you need extra space to complete this form, use a separate sheet of paper.
Application Form . P2

TRAINING AND SEMINAR

Training and Seminar Attended Inclusive Period No. of Training Hours Conducted by

CIVIL SERVICE ELIGIBILITY (INCLUDING BAR OR BOARD EXAMINATION)

Examination Place Date Rating

FAMILY DATA
(Parents, Spouse, Children, Brothers and Sisters) Please put an "+" in the "age" column if family member is deceased.

BIRTH DATE PROFESSION /

FULL NAME AGE RELATION WHERE EMPLOYED
mm/dd/yyyy OCCUPATION
1
2
3
4
5
6
7
8
9
10

MEDICAL HISTORY
Birth Mark Allergies Physical Defect/Major Surgery/Illness

Blood Type Do you wear glasses / contact lenses? Yes No Grade

CHARACTER REFERENCES
Give at least three (3)

Name Position Company/Address Contact Number

1.
2.
3.

Please List down all relatives by consanguinity or affinity to any official or employees of the Department of Energy or any attached agency.
Name of Relative(s) Relation Company Occupation/Position

Have you ever been accused of indicted/tried for the violation of any law, ordinance or regulations before any court or tribunal, or have you ever been accused/charged, or tried
for any breach of infraction of military, naval or constabulary discipline in an administrative action?

Yes No (If yes, give the date and state the nature of offense and penalty)

Have you ever been previously retired or were you given separation pay?

Yes No (If yes, please indicate amount ___________________ )

In case of emergency, who should we notify? Name: Relation:

Address: Phone No.

ALL INFORMATION I HAVE SUPPLIED IN THIS APPLICATION ARE TO THE BEST OF MY KNOWLEDGE, TRUE AND CORRECT.
I UNDERSTAND THAT THIS AUTHORIZES THE MANAGEMENT OF THE DEPARTMENT OF ENERGY TO CONDUCT BACKGROUND CHECK / VERIFICATION
RELATIVE TO THIS APPLICATION. I UNDERSTAND FURTHER THAT ANY DELIBERATELY UNTRUE INFORMATION OR
FALSE STATEMENT GIVEN HERE WILL BE SUFFICIENT CAUSE OF DISQUALIFICATION OF MY APPLICATION AND CAN BECOME A BASIS FOR MY DISMISSAL (IF
AND WHEN HIRED).

Printed Name and Signature Date