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Emp. Code Keri Code Dept. Level Status (BIR)
DO NOT Date Hired Fingercode Location Shift OT hours
Personal Biodata
Surname First Name Middle Name Nickname Age Gender

Permanent Address No. Street City/Province Tel. No. Cellphone No.

Provincial Address No. Street City/Province Tel. No. Religion

Height Weight Blood Type Date of Birth Place of Birth Citizenship Civil Status

Language / Dialect You Speak, Read and Write SSS No. PhilHealth No. PAG-Ibig No. TIN No.

Name Of Father Birthday Occupation/Position Employer Yrs. of Service

Name Of Mother Birthday Occupation/Position Employer Yrs. of Service

Name of Spouse, if married Occupation/Position Employer Yrs. of Service

Siblings - List down all your siblings by ranking them from eldest to youngest
Start Name If studying, name of school , grade/ If working, position, profession, name of company,
Age year, course (if college) address, years of service

Children/ Dependents - List down all children below 21 years of age who depend on you for financial support.

Name Date of Birth Other Details

Medical History
Do You Have Any Present Or Past Medical History Which Will Present Special Consideration As To Job Assignments? If So Indicate The Consideration.

Have You Had Any Illness, Hospitalization Or Accidents In The Past 2 Years? If Yes, Please Explain.

Have You Been Accused Or Convicted For Violating Any Law? _______. If Yes, Please Explain Briefly.

How Did You Learn Of Our Job Openings? (Cross X All That Applies)
Company Website Job Fair Jobstreet Other Website: _______________________________
   
Letter from Suy Sing Job Poster/Placement Office Walk In Referral: ____________________________________
 
Person To Contact In Case Of Emergency Relationship:

Address Of The Person To Notify Contact Number:

Continued at the back

Educational Attainment
Level Degree/Course Taken From (Year)- To (Year) Honors
Name of School and Location/Place

High School


Post College

Special Courses

Civil Service Eligibility/ Board / Bar Exam Passed Rating Date of Exam Place of Exam

Computer Languages / Softwares You know: Articles / Books Written / Published

Employment History

Employer’s Name & Address From- To Position Immediate Contact No. Salary Reason for Leaving
( indicate Full, Part, Summer, OJT) Supervisor

Which Job did You Enjoy Most? Why?

Was There Anything You Particularly Dislike About Any of the Jobs, Why?

References (Give 3 persons, exclude relatives and former employers)

Name Occupation Company/Address Contact No.

General Information
Hobbies, Sports You Play Do You Drive? Have a valid license?

Special Qualifications / Skills, Membership in clubs / Organizations

Are you related to anyone who works for a company that manufactures, wholesales or retails grocery products (soaps, shampoos, canned goods, detergents, milk, sardines,
snack foods etc)? If yes, please explain details.

If Hired, When Can You Start? Do you smoke?

Other Companies You Are Applying At Have You Applied With Us Before? IF Yes, When?

Further Information Which May Be Helpful In Considering Your Qualifications And Interests

I certify that the statements I have made in this application are true and correct that any misrepresentation, falsification or willful omission herein shall be
sufficient reason for dismissal from, or refusal of employment by this company. I authorize this company to investigate the accuracy of the information

___________________________ ____________________________
Date Signature