APPLICATION FOR EMPLOYMENT

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Instructions: This form is an official document. Please answer all (Passport size)
items. If an item is not applicable to you, indicate NA or Not Applicable.
Please check ( ) the appropriate box whenever applicable.

Position Applied For: Have you taken BSP pre-employment test

before? Yes No

1. SURNAME FIRST NAME MIDDLE NAME For female married applicant: write Maiden Name

2. CIVIL STATUS 3. GENDER 4. CITIZENSHIP

Male Female
Single Married Separated Widower/Widow
5. DATE OF BIRTH 6. AGE 7. PLACE OF BIRTH 8. HEIGHT (Meters) 9. WEIGHT (Kilos)

10. PERMANENT ADDRESS 11. E-MAIL ADDRESS 12. CONTACT NUMBER

Course
Name and Address of Inclusive Dates of Honors
13. EDUCATION (If Undergraduate, indicate
School/College/ University Attendance Received
no. of units completed)

Secondary

Vocational

College

Postgraduate

(Continue on separate sheet, if necessary)

14. CIVIL SERVICE ELIGIBILITY/LICENSE 15. SKILLS AND OTHER QUALIFICATIONS 16. MEMBERSHIP IN RELATED
Rating
(specify if BOARD, BAR, etc.) 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

Position Title and Monthly
Inclusive dates Status of Appointment Name and Address of Reason for
(Exact dates) (specify if Permanent, Probationary Company/Agency/Office Basic Salary Allowances Leaving
Temporary, Casual, Contractual, etc.)

(Continue on separate sheet, if necessary)

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HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012
19. Are you related to any official or employee in the BSP:
If yes, give name/s of relative/s and relationship/s
a.) within the third degree of consanguinity (i.e. mother/father,
son/daughter, brother/sister, nephew/niece, uncle/aunt,
grandparent, grandchild)? Yes No

b.) within the second degree of affinity (i.e. mother-in-law/ father-in- If yes, give name/s of relative/s and relationship/s
law, son-in-law/daughter-in-law, brother-in-law/ sister-in-law)?

Yes No If yes, give name/s of relative/s and relationship/s

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 If yes, give name/s, relationship, department and date of
Bangko Sentral ng Pilipinas? Yes No retirement

21. Have you ever been a respondent for a preliminary investigation If “Yes”, state nature of the offense complained of
before the Prosecutor’s/ Fiscal’s Office or any law enforcement Status:
agency such as the police, PDEA, NBI, etc.? Yes No On-going
Dismissed
22. Have you ever been charged of If “Yes”, state nature of offense/crime
Status:
a) an administrative case? Yes No
On-going
b) a criminal case? Yes No Acquitted
Dismissed
23. Have you ever been convicted of any administrative offense If “Yes”, state nature of the offense/case and penalty
or crime? Yes No

24. Have you ever been retired, forced to resign or dropped from If “Yes”, give reasons
employment whether in the public or private sector?
Yes No
If "Yes", give details
25. Have you ever been a candidate in a national or 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 chronic pulmonary disease hematologic condition

diabetes malignancies/cancer chronic liver disease
acquired heart disease autoimmune disease major congenital anomaly/deformation
kidney disease cardiovascular Accident (CVA) others: _____________________________
pulmonary tuberculosis neuro-psychiatric condition _____________________________

27. What is the minimum salary 28. FOR APPLICANTS TO A SECURITY GUARD POSITION ONLY
you are willing to accept? 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.
1. _____________________________________________ ___________________________________________
2. _____________________________________________ ___________________________________________

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HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012
 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.
Community Tax Certificate No. ________________
Issued at ________________________________
Issued on ________________________________
Signature over Printed Name/ Date

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