APPLICATION FOR EMPLOYMENT

Position Applied for : 1st Preference :

RECENT 2” X 2” PICTURE
2nd Preference:
Desired Salary : Not applicable
Mode of Application :  Referred  Job Fair  Walk-in  Online  Others:__________
Name of Referror :

A. PERSONAL

SURNAME FIRST NAME MIDDLE NAME NICKNAME

PERMANENT ADDRESS TEL. NO.

HOME ADDRESS (IF NOT RESIDING IN PERMANENT ADDRESS) TEL. NO.

MOBILE NO.
 OWNED  RENTED  OTHERS __________________________

PROVINCIAL ADDRESS EMAIL ADDRESS

BIRTHPLACE CIVIL STATUS DATE OF MARRIAGE

CITIZENSHIP SEX HEIGHT WEIGHT BLOOD TYPE RELIGION

DISTINGUISHING MARK IN THE FACE HOBBIES/INTERESTS/SPECIAL TALENTS

LANGUAGES SPOKEN

TIN NO. SSS NO. PAG-IBIG NO. PHILHEALTH NO.

B. FAMILY RELATIONS (List immediate family members in this order: parents, brothers, sisters, spouse, children, parents-in-law, children-in-law).
Use a separate sheet if necessary.

RELATIONSHIP BIRTHDATE POSITION/ EMPLOYER/

NAME AGE ADDRESS
TO YOU (MM/DD/YY) SCHOOL

NAME CONTACT NUMBER

PERSON TO NOTIFY
IN CASE OF EMERGENCY: ADDRESS

C. RELATIVES IN THE BANK/ (1st and 2nd degree by consanguinity and affinity in this order: parents, spouse, children, parents-in-law,
children-in-law, grandparents, grandchildren, brothers, sisters, grandparents-in-law, grandchildren-in-law, brothers-in-law and sisters-
in-law) Use a separate sheet if necessary.

NAME RELATIONSHIP TO YOU COMPANY/ UNIT POSITION

MB-V-HR-1/Rev. May 2017 (Item Code: 0405-027)

D. EDUCATION
EDUCATIONAL INCLUSIVE RECOGNITION/
SCHOOL COURSE/ DEGREE
ATTAINMENT DATES HONORS/ AWARDS

Grade School
High School

College
 Graduated ? Gen. Average _____%
Post Graduate

Professional Qualifications/ Licenses ____________________________ Date Obtained: ________________ Grade: __________

E. EMPLOYMENT RECORD (Start from most recent employment)

1. NAME OF EMPLOYER (COMPANY OR FIRM) NATURE OF BUSINESS
PRESENT EMPLOYER

BUSINESS ADDRESS NAME & TITLE OF IMMEDIATE SUPERVISOR

DATE HIRED (MONTH, YEAR) STARTING GROSS MONTHLY PAY STARTING POSITION
Not Applicable
PRESENT GROSS MONTHLY PAY PRESENT POSITION
Not Applicable
2. NAME OF EMPLOYER (COMPANY OR FIRM) NATURE OF BUSINESS
PREVIOUS EMPLOYER

BUSINESS ADDRESS NAME & TITLE OF IMMEDIATE SUPERVISOR

DATE HIRED (MO/YR) DATE RESIGNED (MO/YR) STARTING GROSS MONTHLY PAY STARTING POSITION
Not Applicable
REASON FOR LEAVING LAST GROSS MONTHLY PAY LAST POSITION HELD
Not Applicable
F. PROFESSIONAL OR CHARACTER REFERENCES (List 3 persons NOT RELATED TO YOU)

RELATIONSHIP TO
NAME POSITION COMPANY CONTACT NO. E-MAIL ADDRESS
YOU

G. ADDITIONAL DECLARATIONS

1. Have you been the subject of any investigation by your present or previous employer(s) on any
matter involving or related to your employment? If yes, please provide details.
 YES
 NO

2. Are you aware of any medical condition that may affect your ability and fitness to effectively
perform the duties and responsibilities of the position applied for? If yes, please provide details.
 YES  NO

I hereby affirm that the statements made by me on this application are true and correct and that I have not withheld nor
misrepresented any fact or circumstance which would, if disclosed, affect my application for employment. I understand
that any misrepresentation or omission of any material fact discovered during the course of my employment will be
sufficient ground for my termination.

SIGNATURE OF APPLICANT DATE