Application Form & Questionnaire

Date: Referred By: Known Hiring Thru:

Contact#: Position Applied:

Personal Information:
• First Name: Middle Name: Last Name:
• Present Address:
• How long have you been staying in your present address? Owned? Rented?
• Are you living with whom? Parents Husband/Wife/Partner Son/Daughter Siblings Friends
• Provincial Address:
• Date of Birth: Religion: Citizenship:
• Height: Weight: How many siblings do you have? What is your birth order?
• Civil Status: Do you have a live in partner? Are you part of the 3rd Sex?
• Number of Children: List of their ages:
• Name of Spouse/Partner: Occupation:
• Father's Name: Occupation:
• Mother's Name: Occupation:

Educational Background:
Level of Education Name of School / Location Course / Degree Year Graduated
Elementary

High School

College

Vocational

Work Experience/s:
Company Name: From: To:

Last Position: Salary:

Reason for Leaving:

Company Name: From: To:

Last Position: Salary:

Reason for Leaving:

Company Name: From: To:

Last Position: Salary:

Reason for Leaving:

Character Reference: (Not related to you)

Name Occupation Contact Number

• Do you have a relative/s or friend/s working in our company? Yes No Can you work on:
• Do you have relatives in the government? Yes No • Saturdays? Yes No
• Have you been a member of any Worker’s Union? Yes No • Sundays? Yes No
• Have you ever sued your previous employer/s? Yes No • Holidays? Yes No
• Have you been convicted of a crime? Yes No • Night Shift? Yes No
• Longest time that you were absent from work for the last 5 years?
• List of previous or existing sickness for the last 5 years: • What is the lowest salary you will
• How long do you intend to stay and work with our company? accept?
• If you will be hired, when can you start working?

Interviewer’s Comments: I hereby certify that all information indicated are true and
correct. I understand that any false or omission of information
is a ground for my termination from employment.

Applicant's Name / Signature