APPLICATION FOR EMPLOYMENT

is an official document.
Picture Please
items.
If an item is
(Passport

Instructions: This form

answer all
not applicable to you, indicate NA or Not Applicable.
Please check ( ) the appropriate box whenever applicable.

size)

Position Applied For:

Have you taken BSP pre-employment

test before?
Yes
No

1.

SURNAME
MIDDLE NAME

For female married applicant: write Maiden

Name

FIRST NAME

2. CIVIL STATUS

3. GENDER

4. CITIZENSHIP

Male
Single
Widower/Widow
5. DATE OF BIRTH

Married
6. AGE

7. PLACE OF BIRTH

10. PERMANENT ADDRESS

13.
EDUCATION

Female

Separated

8. HEIGHT (Meters)

11. E-MAIL ADDRESS

Name and Address of

School/College/ University

9. WEIGHT (Kilos)

12. CONTACT NUMBER

Inclusive
Dates of
Attendance

Course
(If Undergraduate, indicate
no. of units completed)

Honors
Received

Secondary
Vocational
College
Postgraduat
e
(Continue on separate sheet, if necessary)

14. CIVIL SERVICE

ELIGIBILITY/LICENSE
(specify if BOARD, BAR, etc.)

Ratin 15. SKILLS AND OTHER

QUALIFICATIONS
g

16. MEMBERSHIP IN
RELATED
ASSOCIATION,
HOBBIES, etc.

(Continue on separate sheet, if necessary)

17. SEMINAR/TRAINING ATTENDED
Title of Seminar/ Training

Inclusive Dates

No. of
Hours

(Continue on separate sheet, if necessary)

18. EMPLOYMENT HISTORY

Inclusive dates
(Exact dates)

Position Title and

Status of Appointment
(specify if Permanent,
Probationary Temporary,
Casual, Contractual, etc.)

Monthly
Name and Address of
Company/Agency/Office

HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012

Basic
Salary

Allowanc
es

Reason for
Leaving

Page 1 of 3

(Continue on separate sheet, if necessary)

19. Are you related to any official or employee in the

If yes, give name/s of relative/s and relationship/s

BSP:
a.) within the third degree of consanguinity (i.e.

mother/father, son/daughter, brother/sister,

nephew/niece, uncle/aunt, grandparent,
grandchild)?
Yes
No

If yes, give name/s of relative/s and relationship/s

b.) within the second degree of affinity (i.e. mother-in-

law/ father-in-law, son-in-law/daughter-in-law, brotherin-law/ sister-in-law)?

Yes

If yes, give name/s of relative/s and relationship/s

No

c.) other relative/s not specified in items a and b?

Yes

No

20. Do you have relative/s who was/were former

employee/s of the
Bangko Sentral ng Pilipinas?
Yes
No
21. Have you ever been a respondent for a preliminary
investigation
before the Prosecutors/ Fiscals Office or any law
enforcement
agency such as the police, PDEA, NBI, etc.?
Yes
No
22. Have you ever been charged of
a) an administrative case?

Yes

b) a criminal case?

No

Yes

If yes, give name/s, relationship, department and

date of retirement
If Yes, state nature of the offense complained of
Status:
On-going
Dismissed
If Yes, state nature of offense/crime
Status:
Ongoing

No

Acquitted

23. Have you ever been convicted of any administrative

offense
or crime?

Yes

Dismissed
If Yes, state nature of the offense/case and
penalty

No

24. Have you ever been retired, forced to resign or

If Yes, give reasons

dropped from
employment whether in the public or private sector ?
Yes

No

25. Have you ever been a candidate in a national or

If "Yes", give details

local election
(except Barangay election)?
Yes
No
26. Please check any ailment/s for which you have been treated or are presently undergoing treatment

hypertension
diabetes
acquired heart
disease
kidney disease
pulmonary

chronic pulmonary disease

malignancies/cancer
autoimmune disease
cardiovascular Accident
(CVA)
neuro-psychiatric condition

HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012

hematologic condition
chronic liver disease
major congenital
anomaly/deformation
others: _____________________________
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tuberculosis

_____________________________

28. FOR APPLICANTS TO A SECURITY GUARD POSITION ONLY

If considered, are you willing to be assigned/re-assigned to the Main/SPC/regional
offices/branches of the Bangko Sentral ng Pilipinas in the performance of your job?
Yes
No
Signature
__________________________________
29. REFERENCES (Persons not related by consanguinity or affinity to applicant)
Name
Address/ Telephone No.

What is the minimum

salary
you are willing to
accept?
27.

1. _____________________________________________

___________________________________________

2. _____________________________________________

___________________________________________

3. _____________________________________________

___________________________________________

I declare that the answers given above are true and correct to the best of my knowledge
and belief. It is understood that any false representation I made above shall disqualify me from
employment in the BSP in which case, my appointment, if one is issued, shall be revoked; such
representation shall be a ground for an administrative case for DISHONESTY and/or CONDUCT
PREJUDICIAL TO THE BEST INTEREST OF THE SERVICE punishable under the disciplinary rules on
administrative cases both in Civil Service Commission and BSP.
I further waive my right to confidentiality of information pertaining to the BSP Watchlist
clearance
in
compliance
with
M.B. Resolution No. 1487.

Signature over Printed Name/ Date

Community Tax Certificate No.

________________
Issued at
________________________________
Issued on
________________________________

HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012

Page 3 of 3