BIO-DATA

PERSONAL DATA

Position Desired :____________________________________________________Date :____________________

Name :____________________________________________________Gender :____________________
City Address :_____________________________________________________________________________________
Provincial Address :_____________________________________________________________________________________
Telephone :____________________________________________________Cellphone :____________________
E-mail Address :____________________________________________________ :____________________
Date of Birth :____________________________________________________Birth of Place :____________________
Civil Status :____________________________________________________Citizenship :____________________
Height :____________________________________________________Weight :____________________
Religion :____________________________________________________
Spouse :____________________________________________________Occupation :____________________
Name of Children :____________________________________________________Date of Birth :____________________
:____________________________________________________ :____________________
:____________________________________________________ :____________________
Father’s Name :____________________________________________________Occupation :____________________
Mother’s Name :____________________________________________________Occupation :____________________
Language or dialect spoken and written: ____________________________________________________________________
Person to be contacted in case of emergency: _______________________________________________________________
His of her address and telephone: _________________________________________________________________________

EDUCATIONAL BACKGROUND

Elementary :___________________________________________________Year Graduated :____________________

High School :___________________________________________________Year Graduated :____________________
College :___________________________________________________Year Graduated :____________________
Degree Received :_____________________________________________________________________________________
Special Skills :_____________________________________________________________________________________

EMPLOYMENT RECORD

Company Name :_____________________________________________________________________________________

Position :___________________________________________________From:______________To:____________

Company Name :_____________________________________________________________________________________

Position :___________________________________________________From:______________To:____________

CHARACTER REFERENCE

Name :___________________________________________________Company :____________________

Position :___________________________________________________Contact No. :____________________

Name :___________________________________________________Company :____________________

Position :___________________________________________________Contact No. :____________________

Saving I here certify that the above information is true and correct
Serving to the best of my knowledge and belief. I also understand
the the that any misinterpretation will be considered reason for
World withdrawal of an offer subsequent dismissal if employed.
Lord

____________________________________________________
Applicant’s Signature
 Serving Saving
the the
Lord World

International Auxiliary Chaplaincy Association

IACA Mission House Rua Do Padre Antonio Roliz, 31 Edif.
Po Mei On 3 Andar-D Macau (Macau DSI Reg.No. 6040

Country: ________________________________
Province: _______________________________

Date: __________
Note: Write Legibly, Use Black Ink Only; Avoid erasures; Fil all Blanks with necessary info.

MEMBERSHIP APPLICATION FORM

NAME: _____________________________________________________________________
Given Name Middle Name Surname

ADDRESS: ___________________________________________________________________
_____________________________________________________________________

BIRTHDAY: _____________(mm/dd/year) AGE: _______ GENDER:__________

PLACE OF BIRTH:___________________________ CIVIL STATUS: _____________________
HIGHEST EDUCATIONAL ATTAINMENT: ___________________________________________
School/University: ___________________________________________________________
Degree: __________________________________ Year: ____________________________

REASON/S WHY YOU WISH TO JOIN IACA

(FYI: Write with your own handwriting and volition)

______________________________________ Date: _____________________

SIGNATURE OVER PRINTED NAME (Applicant)

Reminder: You are executing this documentation in your own free will and volition, the Association
assumes that all details are true of which would be treated with utmost confidentiality. The
association is free from any legal conditions as you are being accepted in GOOD FAITH. You are
likewise to donate an amount of Php1,500 – (____________ Equivalent Currency Overseas) only as
your Membership Love Gift share to the association (serves also as your equity).

National Director: ______________________ Status of Applicant: ____________________

(REPUBLIC OF THE PHILIPPINES)

SWORN STATEMENT

I, ________________________________________________of legal age, Filipino and

resident of ________________________________________________after having duly sworn
to in accordance with the law, hereby depose and state:

I am applying as a MEMBER of the INTERNATIONAL AUXILIARY

CHAPLAINCY ASSOCIATION with office address located at IACA Mission House-Rua Do
Padre Antonio Roliz, 31 Edif. Po Mei On 3 Andar-D Macau (Macau DSI Reg. No.6040).

That I voluntarily applied as a member of the International Auxiliary Chaplaincy

Association of which nobody forced nor influenced me to be part of this institution.

Therefore, I am executing this affidavit in good faith to affirm the foregoing facts of
whatever purpose this may serve.

In witness thereof, I hereby signed this affidavit this ______________ day of

_____________ at ____________________________.

________________________________________
Signature

SUBSCRIBED AND SWORN TO before me this__________ day of ______, 20_____

At ________________________affiant exhibited to me this __________________
issued on ______________________ at ______________________.

Notary Public

Doc. No. ________

Page No. ________
Book No. ________
Series of 20 ______