UTHMAN BIN AFFAN FOUNDATION ACADEMY INC.

APPLICATION FORM

Application No.: ____________

I. PERSONAL INFORMATION

PACAS SHAIRA MICAH BARTOCES

Last name First name Middle name

APRIL 1, 1996 OROQUIETA CITY FEMALE SINGLE

Date of Birth Place of Birth Gender Civil Status

2ND FLOOR, ESG BUILDING, LLUCH ST., POBLACION, ILIGAN CITY, LANAO DEL NORTE, 9200

(Current Address) House no. Street Barangay City/ Municipal Province Zip code

BLK. 4 LOT 13, PHASE 1, TRANSVILLE VILLAFLOR, OROQUIETA CITY, MISAMIS OCCIDENTAL, 7200

(Permanent Address) House no./ street Barangay City/ Municipal Province Zip code

FILIPINO ISLAM CEBUANO N/A

Citizenship Religion Tribe Telephone No.

09954686036, 09103113727 micahpacas@gmail.com

Mobile No. Email Address (if any)

II. FAMILY BACKGROUND

N/A N/A N/A N/A
Spouse’s Last Name First Name Middle Name Occupation

PACAS ROGELIO JR. DUHAYLUNGSOD

Father’s Last Name First Name Middle Name

BARTOCES JINKIE BARORO

Mother’s(Maiden) Last Name First Name Middle Name

III. EDUCATIONAL BACKGROUND

Period of
Attendace
Basic Year
Education/Degree/Course Graduated
Level Name of School
From To

Elementary ORQUIETA CITY NATIONAL SPECIAL SCIENCE 2003 2009 2009

ELEMENTARY SCHOOL PROGRAM

Secondary MISAMIS OCCIDENTAL SPECIAL SCIENCE 2009 2013 20013

NATIONAL HIGH SCHOOL PROGRAM

College MINDANAO STATE BACHELOR IN SECONDARY 2013 2017 2017

UNIVERSITY - ILIGAN EDUCATION major in
INSTITUTE OF TECHNOLOGY AND
TECHNOLOGY LIVELIHOOD EDUCATION

Graduate MINDANAO STATE LAW 2019 ONGOING N/A

Studies UNIVERSITY - ILIGAN
INSTITUTE OF
TECHNOLOGY

Others TESDA COOKERY (NCII) 2019 2019

Government /Licensing Exam Passed

LICENSURE FOR TEACHERS BOARD EXAMINATION

Professional Certifications

COOKERY NC II

Membership in Professional Organizations, Associations, etc.

RISALE-I NUR INSTITUTION (volunteer)

GPA (Grade Point Average)

2.05

IV. SCHOLASTIC INFORMATION

Academic achievements, honors, awards received in college/university

N/A

Have you ever been convicted of a felony?

[ ] YES [*] NO

V. WORK EXPERIENCE (Include private employment.)

Department/ Agency/ Office/ Company Position Employment Period Monthly Salary

(write in full)

CUSTOMER 2017-2018 15,000

SERVICE
TELEPERFORMANCE REPRESENTATIVE

APPLESEED MONTESSORI PRESCHOOL 2018 18,000

PRESCHOOL TEACHER

SILVER EDGE MEDIA SEO SPECIALIST 2019 15,000

 VI. REFERENCES (Person not related by consanguinity or affinity to applicant/appointee)

Name Address Telephone. No.

ILIGAN CITY, LANAO DEL NORTE 09480653822

MA. JEANIFER TROCIO

JELLA MAE GARCIA QUEZON CITY, METRO MANILA 09773694014

OROQUIETA CITY, MISAMIS 09569329892

OCCIDENTAL
JINKIE B. PACAS

VII. CERTIFICATION

I hereby certify that I have read and fully understood all the instructions regarding my application for admission to
Uthman Bin Affan Foundation Academy Inc. and that the informations stated in this application form are correct and
complete. I understand that incomplete or inaccurate information could be prejudiced to my application. If accepted as an
employee of UBAFAI, I agree to abide all its policies and regulations.

11/20/2019
APPLICANT’S SIGNATURE DATE