Anda di halaman 1dari 5

APPLICANTS INFORMATION SHEET

Name (Surname) (First) (Middle) Position Applied For Salary Desired

Nickname Telephone No. Mobile No. Email

Current Address:

(No. & Name of Street) (Barangay) (City/Municipality) (Province) (Zip Code)


Permanent Address:

(No. & Name of Street) (Barangay) (City/Municipality) (Province) (Zip Code)


Provincial Address:

(No. & Name of Street) (Barangay) (City/Municipality) (Province) (Zip Code)

Ever applied with any of our affiliates before?  Yes  No

GENERAL INFORMATION

Sex Height Weight Date of Birth Place of Birth Age

Blood Type Race Eye Color Hair Color Religion Citizenship

SSS No. TIN No. PAGIBIG No. Phil Health No.

Marital Status Single  Own Home


 Renting Home
Married  Living with parents
 Relatives
Separated  In-Laws
 Others
Marriage Date: ______________________

No. of Children : ______________________

Name of: (Surname) (First) (Middle) Occupation / Employer Date of Birth


FATHER

MOTHER

OP-ADM-201/F02.04 Page 1 of 5 Effective Date: 09 Sep 2011


Name of: (Surname) (First) (Middle) Occupation / Employer Date of Birth
BROTHER

SISTER:

Name of: (Surname) (First) (Middle) Occupation / Employer Date of Birth


SPOUSE

CHILDREN:

QUALIFICATIONS AND ATTAINMENT

Educational Attainment
Course School Date Attended Year Title/Degree
From : To Graduated
Elementary

High School

College

Graduate

Others

OP-ADM-201/F02.04 Page 2 of 5 Effective Date: 09 Sep 2011


Government, Civil Service, Board Exams Record
Kind of Examination Date Examination Rating License No.

Seminars & Other Training Attended


Course Title Inclusive Dates Conducted by Grade/Cert.

OTHER QUALIFICATIONS
Awards, Commendations or Scholarship

Driving  License No. ___________________ Any Allergies _______________________________


Any physical disability ________________________
Office Specify ________________________ Any recurring illness __________________________
_________________________________________
_________________________________________
Smoker  Yes  No
Hobbies ___________________________________
Arts 
Specify _________________________ __________________________________________
_________________________________________ __________________________________________

OP-ADM-201/F02.04 Page 3 of 5 Effective Date: 09 Sep 2011


EMPLOYMENT HISTORY (LAST THREE JOBS)

1 2 3

Position Title

Employer

Address

Telephone No.
Employment Type
(Regular,Temporary-Direct Hire/
Project / Trainee)

Superior’s Name / Position

Employer’s TIN No.

FROM TO FROM TO FROM TO

Date of
Employment

Salary

Reason for Leaving

Work Description

Have you ever been dismissed from any of your jobs ?  Yes  No
If yes, please specify _______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Have ever been arrested?  Yes  No
Have you ever been involved as a defendant in any crime in court?  Yes  No
If yes, explain. ____________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

OP-ADM-201/F02.04 Page 4 of 5 Effective Date: 09 Sep 2011


In case of EMERGENCY, please notify:

Name Relationship Address Telephone No.

CHARACTER REFERENCES
Name Relationship Address Telephone No.

RELATIVES WORKING WITH AMHERST PARENTERALS, INC.


Name Relationship Address Telephone No.

I hereby certify that the above information is true


and correct. I relieve AMHERST PARENTERALS,
INC. from any liability resulting from verifying the
above information and data.

________________________ ________
SIGNATURE OVER PRINTED NAME DATE

OP-ADM-201/F02.04 Page 5 of 5 Effective Date: 09 Sep 2011