APPLICATION FORM

Order of
Preference Item No. Position Title SG

48-01-0189 Social Insuance Officer I 11

1

48-01-0190 Social Insurance Officer I 11

2

51-01-0203 Social Insurance Assistant I 8

3

Name EARL ALDWIN S. YOUNG

Present Position/SG Social Insurance Assistant I / SG 8

Present Employment Status CASUAL

Present Department/PRO (AgenHCDMD / PRO8

AUTHORITY TO CONDUCT BACKGROUND CHECKS

I hereby authorize PhilHealth to make inquiry about and receive information about my s
for employment/promotion. I give permission to persons contacted to provide such info
Such inquiries may include, but are not limited to the quality and quantity of my wo
record, qualifications, education, and disciplinary records. I hereby waive, release and ag
to sue any person or organization for any result of providing, obtaining or acting up
information. I understand that such information is sought with confidentiality, and I
request copies of such information. A copy of this authorization shall be effective as the or
Signature

Date 4/12/2018
 ANNEX D

PPLICATION FORM

Department/PRO

PRO 8

PRO 8

PRO 8

O CONDUCT BACKGROUND CHECKS

ake inquiry about and receive information about my suitability
permission to persons contacted to provide such information.
re not limited to the quality and quantity of my work, work
d disciplinary records. I hereby waive, release and agreed not
for any result of providing, obtaining or acting upon such
ch information is sought with confidentiality, and I will not
A copy of this authorization shall be effective as the original.
 ANNEX D-1
APPLICANTS DATA MATRIX FORM

Name of Applicant: EARL ALDWIN S. YOUNG

ID picture taken within
Applying for the position of Social Insurance Officer I / SG 11 the last 6 months
3.5 cm. X 4.5 cm
(indicate title (passport size)
and SG):
Order of Preference: Computer generated
Item Number: 48-01-0189
/
or xerox copy of picture
is not acceptable
First Second Third

Office/Department: LHIO Tacloban

EDUCATION
College (Degree/Year Graduated) Bachelor of Science in Nursing, 2012
Master's Degre/Year Graduated Master in Public Resource Management, 2018
Doctorate Degree/Year Graduated

Others

Honor/Awards Received

ELIGIBILITY
Rating Title of Eligibility/Board/Bar

79.00% Philippine Nursing Licensure Examination: RA 1080

EXPERIENCE
No. of Years Position Company/Agency Name Date Covered Brief Job Description:

PHILIPPINE HEALTH
SOCIAL INSURANCE INSURANCE
0.16 ASSISTANT I CORPORATION 2-24-18 - PRESENT Monitor HCI performance and eClaim implementation of all HCIs.

Project ReachOut which streamlines projects, forums and events related to active
CLERK III 7/1/2015 - 2/24/18
engagment and payment for the healthcare providers
PHILIPPINE HEALTH
INSURANCE
2.5 CORPORATION

SOCIAL INSURANCE 4/24/2013 - 6/30/2015

2.17 ASSISTANT I
PHILIPPINE HEALTH
INSURANCE Project ReachOut which streamlines projects, forums and events related to active
CORPORATION engagment and payment for the healthcare providers
EXPERT GLOBAL
REPRESENTATIVE, SOLUTIONS - RMH
0.25 CUSTOMER SERVICE TELESERVICES ASIA
1/14/2013 - 4/16/2013 Call center agent incharge in sales and product suport
PACIFIC INC

Total No. of Years: 5.08 Please use additional sheet if necessary

TRAINING AND SEMINAR (Note: Only Trainings/Seminars/Workshops attended within the last ten (10) years from the date of application shall be included)
No. of Hours Title of Training/Seminar/Workshop Date Covered Provider
16 REACHOUT FORUM 2016 / PRESENTATIONS SKILLS TRAINING 8/16/2016 - 8/17/2016 PhilHealth Regional Office VIII
4 SOCIAL HEALTH INSURANCE EDUCATION SERIES (SHINES) 5/23/2016 PhilHealth Regional Office VIII
The Real Aldternatice Investment Multipurpose
8 PRE-MEMBERSHIP EDUCATION SEMINAR ON COOPERATIVES 4/18/2016 Cooperative
8 GENDER SENSITIVITY TRAINING 3/30/2016 PhilHealth Regional Office VIII

8 SEMINAR IN COOPERATIVE AND ENTERPRENEURSHIP; THE CASE OF THE NASAKASECO

3/13/2016 Eastern Visayas State University (Graduate School)

8 HCDMD YEAR-END ASSESSMENT AND STRATEGIC PLANNING FOR 2016 CUM TEAMBUILDING
12/12/2015 PhilHealth Regional Office VIII
16 3RD INFORMATION CARAVAN FOR 2015 10/26/2015 - 10/27/15 PhilHealth Central (Corcom)
16 REACH OUT POLICY WRITESHOP 10/21/2015 - 10/22/2015 PhilHealth Central Office
16 REACH OUT SUMMIT / FACILITATORS TRAINING 8/18/2015 - 8/19/2015 PhilHealth Central Office
16 2ND INFORMATION CARAVAN OF 2015 7/27/2015 - 7/28/2015 PhilHealth Central (Corcom)
16 1ST INFORMATION CARAVAN FOR 2015 4/27/2015 - 4/28/2015 PhilHealth Central (Corcom)
16 ISO 9001:2008 QUALITY MANAGEMENT SYSTEM (QMS) TRAINING 4/7/2016 - 4/8/2016 PhilHealth Regional Office VIII
24 COMPREHENSIVE RETOOLING FOR CARES 12/17/2014 - 12/19/2014 PhilHealth Regional Office VIII
8 ICD 10 CLASSIFICATION & CLAIMS QUALITY CONTROL TECHNIQUES TRAINING 8/1/2014 PhilHealth Regional Office VIII

8 ORIENTATION ON CLIMATE CHANGE AND EMPLOYEES WELLNESS PROGRAM

2/26/2014 PhilHealth Regional Office VIII AND DOH
IMPLEMENTATION OF ALL CASE RATES, NEW BENEFIT AVAILMENT FORMS AND PROCESSING OF BENEFIT
8 CLAIMS 9/27/2013 PhilHealth Regional Office VIII
8 PREVENTS ORIENTATION (PRIMARY CARE REVITALIZED AND ENHANCED THROUGH SKILLS AND SERVICES) PhilHealth Central Office thru United Nations
6/14/2013 Population Fund
8 CUSTOMER SERVICE PLUS 6/11/2013 PhilHealth Regional Office VIII

16 PERSONAL MASTERY: ROAD TO COMMITMENT, INTEGRITY AND ACCOUNTABILITY

4/6/13 - 4/7/13 PhilHealth Regional Office VIII

Total No. of Hours: 228 Please use additional sheet if necessary

OTHER QUALIFICATION/SKILLS

OTHER PERSONAL INFORMATION

Sex: / MALE FEMALE Home Phone: (053)526-9830

Pursuant to Magna Carta for Disabled Persons (RA 7277), kindly check the appropriate box: Mobile Phone: 09178198055
Are you differently abled?

YES NO If YES, please specify: Email Address: earlaldwinyoung@gmail.com

EARL ALDWIN S. YOUNG EMMANUEL C. MONTILLA

(Signature of Applicant over Printed Name and Date Signed) (Signature of HR Staff over Printed Name and Date Signed)
I hereby certify that all the information written are true and corect. I hereby certify that all the information contained herein have supporting documents submitted by the applicant.
 ANNEX D-1
APPLICANTS DATA MATRIX FORM

Name of Applicant: EARL ALDWIN S. YOUNG

ID picture taken within
Applying for the position of Social Insurance Officer I / SG 11 the last 6 months
3.5 cm. X 4.5 cm
(indicate title (passport size)
and SG):
Order of Preference: Computer generated
Item Number: 48-01-0190 /
or xerox copy of picture
is not acceptable
First Second Third

Office/Department: LHIO Tacloban

EDUCATION
College (Degree/Year Graduated) Bachelor of Science in Nursing, 2012
Master's Degre/Year Graduated Master in Public Resource Management, 2018
Doctorate Degree/Year Graduated

Others

Honor/Awards Received

ELIGIBILITY
Rating Title of Eligibility/Board/Bar

79.00% Philippine Nursing Licensure Examination: RA 1080

EXPERIENCE
No. of Years Position Company/Agency Name Date Covered Brief Job Description:

PHILIPPINE HEALTH
SOCIAL INSURANCE INSURANCE
0.16 ASSISTANT I CORPORATION 2-24-18 - PRESENT Monitor HCI performance and eClaim implementation of all HCIs.

Project ReachOut which streamlines projects, forums and events related to active
CLERK III 7/1/2015 - 2/24/18
engagment and payment for the healthcare providers
PHILIPPINE HEALTH
INSURANCE
2.5 CORPORATION

SOCIAL INSURANCE 4/24/2013 - 6/30/2015

2.17 ASSISTANT I
PHILIPPINE HEALTH
INSURANCE Project ReachOut which streamlines projects, forums and events related to active
CORPORATION engagment and payment for the healthcare providers
EXPERT GLOBAL
REPRESENTATIVE, SOLUTIONS - RMH
0.25 CUSTOMER SERVICE TELESERVICES ASIA
1/14/2013 - 4/16/2013 Call center agent incharge in sales and product suport
PACIFIC INC

Total No. of Years: 3.92 Please use additional sheet if necessary

TRAINING AND SEMINAR (Note: Only Trainings/Seminars/Workshops attended within the last ten (10) years from the date of application shall be included)
No. of Hours Title of Training/Seminar/Workshop Date Covered Provider
16 REACHOUT FORUM 2016 / PRESENTATIONS SKILLS TRAINING 8/16/2016 - 8/17/2016 PhilHealth Regional Office VIII
4 SOCIAL HEALTH INSURANCE EDUCATION SERIES (SHINES) 5/23/2016 PhilHealth Regional Office VIII
The Real Aldternatice Investment Multipurpose
8 PRE-MEMBERSHIP EDUCATION SEMINAR ON COOPERATIVES 4/18/2016 Cooperative
8 GENDER SENSITIVITY TRAINING 3/30/2016 PhilHealth Regional Office VIII

8 SEMINAR IN COOPERATIVE AND ENTERPRENEURSHIP; THE CASE OF THE NASAKASECO

3/13/2016 Eastern Visayas State University (Graduate School)

8 HCDMD YEAR-END ASSESSMENT AND STRATEGIC PLANNING FOR 2016 CUM TEAMBUILDING
12/12/2015 PhilHealth Regional Office VIII
16 3RD INFORMATION CARAVAN FOR 2015 10/26/2015 - 10/27/15 PhilHealth Central (Corcom)
16 REACH OUT POLICY WRITESHOP 10/21/2015 - 10/22/2015 PhilHealth Central Office
16 REACH OUT SUMMIT / FACILITATORS TRAINING 8/18/2015 - 8/19/2015 PhilHealth Central Office
16 2ND INFORMATION CARAVAN OF 2015 7/27/2015 - 7/28/2015 PhilHealth Central (Corcom)
16 1ST INFORMATION CARAVAN FOR 2015 4/27/2015 - 4/28/2015 PhilHealth Central (Corcom)
16 ISO 9001:2008 QUALITY MANAGEMENT SYSTEM (QMS) TRAINING 4/7/2016 - 4/8/2016 PhilHealth Regional Office VIII
24 COMPREHENSIVE RETOOLING FOR CARES 12/17/2014 - 12/19/2014 PhilHealth Regional Office VIII
8 ICD 10 CLASSIFICATION & CLAIMS QUALITY CONTROL TECHNIQUES TRAINING 8/1/2014 PhilHealth Regional Office VIII

8 ORIENTATION ON CLIMATE CHANGE AND EMPLOYEES WELLNESS PROGRAM

2/26/2014 PhilHealth Regional Office VIII AND DOH
IMPLEMENTATION OF ALL CASE RATES, NEW BENEFIT AVAILMENT FORMS AND PROCESSING OF BENEFIT
8 CLAIMS 9/27/2013 PhilHealth Regional Office VIII
8 PREVENTS ORIENTATION (PRIMARY CARE REVITALIZED AND ENHANCED THROUGH SKILLS AND SERVICES) PhilHealth Central Office thru United Nations
6/14/2013 Population Fund
8 CUSTOMER SERVICE PLUS 6/11/2013 PhilHealth Regional Office VIII

16 PERSONAL MASTERY: ROAD TO COMMITMENT, INTEGRITY AND ACCOUNTABILITY

4/6/13 - 4/7/13 PhilHealth Regional Office VIII

Total No. of Hours: 228 Please use additional sheet if necessary

OTHER QUALIFICATION/SKILLS

OTHER PERSONAL INFORMATION

Sex: / MALE FEMALE Home Phone: (053)526-9830

Pursuant to Magna Carta for Disabled Persons (RA 7277), kindly check the appropriate box: Mobile Phone: 09178198055
Are you differently abled?

YES NO If YES, please specify: Email Address: earlaldwinyoung@gmail.com

EARL ALDWIN S. YOUNG EMMANUEL C. MONTILLA

(Signature of Applicant over Printed Name and Date Signed) (Signature of HR Staff over Printed Name and Date Signed)
I hereby certify that all the information written are true and corect. I hereby certify that all the information contained herein have supporting documents submitted by the applicant.
 ANNEX D-1
APPLICANTS DATA MATRIX FORM

Name of Applicant: EARL ALDWIN S. YOUNG

ID picture taken within
Applying for the position of Social Insurance Officer I / SG 11 the last 6 months
3.5 cm. X 4.5 cm
(indicate title (passport size)
and SG):
Order of Preference: Computer generated
Item Number: 51-01-0203 /
or xerox copy of picture
is not acceptable
First Second Third

Office/Department: LHIO Borongan

EDUCATION
College (Degree/Year Graduated) Bachelor of Science in Nursing, 2012
Master's Degre/Year Graduated Master in Public Resource Management, 2018
Doctorate Degree/Year Graduated

Others

Honor/Awards Received

ELIGIBILITY
Rating Title of Eligibility/Board/Bar

79.00% Philippine Nursing Licensure Examination: RA 1080

EXPERIENCE
No. of Years Position Company/Agency Name Date Covered Brief Job Description:

PHILIPPINE HEALTH
SOCIAL INSURANCE INSURANCE
0.16 ASSISTANT I CORPORATION 2-24-18 - PRESENT Monitor HCI performance and eClaim implementation of all HCIs.

Project ReachOut which streamlines projects, forums and events related to active
CLERK III 7/1/2015 - 2/24/18
engagment and payment for the healthcare providers
PHILIPPINE HEALTH
INSURANCE
2.5 CORPORATION

SOCIAL INSURANCE 4/24/2013 - 6/30/2015

2.17 ASSISTANT I
PHILIPPINE HEALTH
INSURANCE Project ReachOut which streamlines projects, forums and events related to active
CORPORATION engagment and payment for the healthcare providers
EXPERT GLOBAL
REPRESENTATIVE, SOLUTIONS - RMH
0.25 CUSTOMER SERVICE TELESERVICES ASIA
1/14/2013 - 4/16/2013 Call center agent incharge in sales and product suport
PACIFIC INC

Total No. of Years: 3.92 Please use additional sheet if necessary

TRAINING AND SEMINAR (Note: Only Trainings/Seminars/Workshops attended within the last ten (10) years from the date of application shall be included)
No. of Hours Title of Training/Seminar/Workshop Date Covered Provider
16 REACHOUT FORUM 2016 / PRESENTATIONS SKILLS TRAINING 8/16/2016 - 8/17/2016 PhilHealth Regional Office VIII
4 SOCIAL HEALTH INSURANCE EDUCATION SERIES (SHINES) 5/23/2016 PhilHealth Regional Office VIII
The Real Aldternatice Investment Multipurpose
8 PRE-MEMBERSHIP EDUCATION SEMINAR ON COOPERATIVES 4/18/2016 Cooperative
8 GENDER SENSITIVITY TRAINING 3/30/2016 PhilHealth Regional Office VIII

8 SEMINAR IN COOPERATIVE AND ENTERPRENEURSHIP; THE CASE OF THE NASAKASECO

3/13/2016 Eastern Visayas State University (Graduate School)

8 HCDMD YEAR-END ASSESSMENT AND STRATEGIC PLANNING FOR 2016 CUM TEAMBUILDING
12/12/2015 PhilHealth Regional Office VIII
16 3RD INFORMATION CARAVAN FOR 2015 10/26/2015 - 10/27/15 PhilHealth Central (Corcom)
16 REACH OUT POLICY WRITESHOP 10/21/2015 - 10/22/2015 PhilHealth Central Office
16 REACH OUT SUMMIT / FACILITATORS TRAINING 8/18/2015 - 8/19/2015 PhilHealth Central Office
16 2ND INFORMATION CARAVAN OF 2015 7/27/2015 - 7/28/2015 PhilHealth Central (Corcom)
16 1ST INFORMATION CARAVAN FOR 2015 4/27/2015 - 4/28/2015 PhilHealth Central (Corcom)
16 ISO 9001:2008 QUALITY MANAGEMENT SYSTEM (QMS) TRAINING 4/7/2016 - 4/8/2016 PhilHealth Regional Office VIII
24 COMPREHENSIVE RETOOLING FOR CARES 12/17/2014 - 12/19/2014 PhilHealth Regional Office VIII
8 ICD 10 CLASSIFICATION & CLAIMS QUALITY CONTROL TECHNIQUES TRAINING 8/1/2014 PhilHealth Regional Office VIII

8 ORIENTATION ON CLIMATE CHANGE AND EMPLOYEES WELLNESS PROGRAM

2/26/2014 PhilHealth Regional Office VIII AND DOH
IMPLEMENTATION OF ALL CASE RATES, NEW BENEFIT AVAILMENT FORMS AND PROCESSING OF BENEFIT
8 CLAIMS 9/27/2013 PhilHealth Regional Office VIII
8 PREVENTS ORIENTATION (PRIMARY CARE REVITALIZED AND ENHANCED THROUGH SKILLS AND SERVICES) PhilHealth Central Office thru United Nations
6/14/2013 Population Fund
8 CUSTOMER SERVICE PLUS 6/11/2013 PhilHealth Regional Office VIII

16 PERSONAL MASTERY: ROAD TO COMMITMENT, INTEGRITY AND ACCOUNTABILITY

4/6/13 - 4/7/13 PhilHealth Regional Office VIII

Total No. of Hours: 228 Please use additional sheet if necessary

OTHER QUALIFICATION/SKILLS

OTHER PERSONAL INFORMATION

Sex: / MALE FEMALE Home Phone: (053)526-9830

Pursuant to Magna Carta for Disabled Persons (RA 7277), kindly check the appropriate box: Mobile Phone: 09178198055
Are you differently abled?

YES NO If YES, please specify: Email Address: earlaldwinyoung@gmail.com

EARL ALDWIN S. YOUNG EMMANUEL C. MONTILLA

(Signature of Applicant over Printed Name and Date Signed) (Signature of HR Staff over Printed Name and Date Signed)
I hereby certify that all the information written are true and corect. I hereby certify that all the information contained herein have supporting documents submitted by the applicant.