BACKGROUND INVESTIGATION FORM

Please fill all information in PRINTED. If item is not applicable put “N/A”
CANDIDATE’S DETAILS
Applicant's Name: DIAZ YANICE COLEEN BELOYA
Surname Given Name Complete Middle Name Suffix (Jr./Sr/ III,etc)

Civil Status: SINGLE Gender: FEMALE Birth Date: (MM/DD/YYYY) 09/15/1998

Contact Number: 09269976574 Email Address: dIazyanicecoleen@gmail.com

SSS Number: 34-6655555-2 Philhealth Number: 02-026880471-5

Pag-ibig Number: 1211-9590-0722 Tax Identification Number: n/a

Current Address: 1218 Estimada Interior Brgy 8, Dagat-dagatan Caloocan City

Permanent Address: 153 F Ignacio Street Sta Ines Proper Brgy. Sta Ines Plaridel, Bulacan Province

ADDRESS CHECK
Please provide a sketch of your current address

EMERGENCY CONTACT PERSON:

Contact 1: Marry Jean Diaz Relationship: Mother Contact Number:09322391781

Contact 2: Jose C Diaz Relationship: Father Contact Number:09197611618

RELATIVES WORKING IN CONCENTRIX:

Name Relationship Position

N/A N/A N/A
N/A N/A N/A
N/A N/A N/A

Rev 07.09.2020
 BACKGROUND INVESTIGATION

AUTHORIZATION FOR EDUCATION CHECK

To the Registrar's Office

To whom it may concern:

This is to authorize confirmation and verification of Concentrix, through their official representative, on
my education records based on my declared information below:

Highest Education Attainment:

O Post-Graduate Degree (Doctorate, Masters)
O Post-Graduate Level (Doctorate, Masters)
O College Graduate
O 1 year College (Completed OR With back subjects)
st
O High School Graduate (ALS passer OR old curriculum)
O Senior High School Graduate (K-12)
O K-12 Undergraduate

O 2nd year College (Completed OR With back subjects)

O 3rd year College (Completed OR With back subjects)
O 4th year College (Completed OR With back subjects)
O Diploma/ Associate/ Vocational Course (specify # of year/s )

Name of Institution (College/Post Graduate): POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Address / Branch: STA MESA MANILA _
Contact Details: 632-5335-1787
Name in school records: YANICE COLEEN BELOYA DIAZ _
Degree/Course: BSED MAJOR IN ENGLISH _
Date of Graduation (if applicable - for College Graduate only) MM/DD/YYYY: 05 _/_ 08 /2019 _
Student ID: 2015-11872-MN-0 _
Dates Attended: From: 06 _/ 10 /_ 2015 _To: 05 /08_ /2019
MM / DD / YYYY MM / DD / YYYY

Name of Institution (High School):

CALOOCAN HIGH SCHOOL
Address / Branch: 10TH AVENUE GRACE PARK CALOOCAN CITY
Contact Details: NA
Name in school records: YANICE COLEEN BELOYA DIAZ _
Date of Graduation (if applicable - for High School Graduateonly) MM/DD/YYYY: 03 /27 /2015
Student ID: NA_ Section: 4-1
Dates Attended: From: 06 /01 /2011 To: 03 / 27 _/_ 2015
MM / DD / YYYY MM / DD / YYYY

Kindly extend due courtesy upon request of relevant information deemed necessary in completion of
the education checks.

Thank you.

DIAZ, YANICE COLEEN B. / 09-04-2020

Signature over Printed Name / Date Signed
Rev 07.09.2020
EMPLOYMENT HISTORY DETAILS
1. NAME OF ORGANIZATION: WNS
ADDRESS: EASTWOOD QC
EMPLOYMENT DATE From (MM/DD/YYYY): 03 / 30 /2017 To (MM/DD/YYYY): 08 /18 /2017
POSITION (Upon hiring): CSR POSITION (Upon leaving): CSR
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: NA CONTACT NUMBER: NA
Reason for Leaving: HEALTH ISSUES Recruiter Remarks (R/O):

2. NAME OF ORGANIZATION: 24/7 INTOUCH

ADDRESS:UP TOWN CENTER , QC
EMPLOYMENT DATE From (MM/DD/YYYY): 04 / 30 /2018 To (MM/DD/YYYY): 04 /01 /2018
POSITION (Upon hiring): EMAIL SUPPORT POSITION (Upon leaving): EMAIL SUPPORT
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: NA CONTACT NUMBER: NA
Reason for Leaving: GRADUATION REQUIREMENTS Recruiter Remarks (R/O):

3. NAME OF ORGANIZATION: ALORICA

ADDRESS: CENTRIS QC
EMPLOYMENT DATE From (MM/DD/YYYY): 05 / 17 /2019 To (MM/DD/YYYY): 07 /30 /2019
POSITION (Upon hiring): CSR POSITION (Upon leaving): CSR
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: NA CONTACT NUMBER: NA
Reason for Leaving: WAS NOT ABLE TO PASS CERTIFICATION Recruiter Remarks (R/O):

4. NAME OF ORGANIZATION: N/A

ADDRESS: N/A
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): N/A POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: N/A CONTACT NUMBER:
Reason for Leaving: N/A Recruiter Remarks (R/O):

5. NAME OF ORGANIZATION: N/A

ADDRESS: N/A
EMPLOYMENT DATE From (MM/DD/YYYY): / / To (MM/DD/YYYY): / /
POSITION (Upon hiring): POSITION (Upon leaving):
NATURE OF EMPLOYMENT: □ Full-Time □ Part-Time □ Self-Employed □ Internship
IMMEDIATE SUPERVISOR: N/A CONTACT NUMBER:
Reason for Leaving: N/A Recruiter Remarks (R/O):

NOTE: If you have more than 5 employment history, please ask the Front
desk/Recruiter to provide another sheet of employment history details.

Rev 07.09.2020
PROFESSIONAL CHARACTER REFERENCE

Please provide us details of four (10) professional character references who have known you from your previous
job(s). These character references should be your Immediate Supervisor, Manager, or Colleague.

FOR FRESH GRADUATES: Please provide us details of four (10) character references who have known you in
the last 3 years. (Highschool Teacher / Professors/ Instructors / OJT Supervisor)
Note: Friends and relatives are NOT valid references.

PROFESSIONAL CHARACTER REFERENCE 1

NAME OF REFERENCE CYRIL BAUTISTA
COMPANY & POSITION: ESL
PROFESSIONAL CHARACTER REFERENCE 2
NAME OF REFERENCE DENISE JUSTALERO
COMPANY & POSITION: TASK US CSR
PROFESSIONAL CHARACTER REFERENCE 3
NAME OF REFERENCE JUDIE JOGO
COMPANY & POSITION: ENGLISH TEACHER
PROFESSIONAL CHARACTER REFERENCE 4
NAME OF REFERENCE JONIEL ASAS
COMPANY & POSITION: DATA ANALYST
PROFESSIONAL CHARACTER REFERENCE 5
NAME OF REFERENCE PEARL ABARRI
COMPANY & POSITION: ALORICA CSR
PROFESSIONAL CHARACTER REFERENCE 6
NAME OF REFERENCE AIRA GUANGCO
COMPANY & POSITION: CSR
PROFESSIONAL CHARACTER REFERENCE 7
NAME OF REFERENCE IRISH GUANGCO
COMPANY & POSITION: TSR
PROFESSIONAL CHARACTER REFERENCE 8
NAME OF REFERENCE DALIA RAMIREZ
COMPANY & POSITION: 24/7 INTOUCH TL
PROFESSIONAL CHARACTER REFERENCE 9
NAME OF REFERENCE JERRY OBLADO
COMPANY & POSITION: QA MANAGER IN ALORICA
PROFESSIONAL CHARACTER REFERENCE 10
NAME OF REFERENCE MAR CAPULONG
COMPANY & POSITION: SHOPPE SITE WORKER
RELATIONSHIP: Colleague_________________
CONTACT DETAILS: 093934897
RELATIONSHIP: Colleague_________________
CONTACT DETAILS: 09561346046
RELATIONSHIP: Colleague
CONTACT DETAILS: 09199362527
RELATIONSHIP: Colleague
CONTACT DETAILS: 09357315917
RELATIONSHIP: Colleague
CONTACT DETAILS: 09554755601
RELATIONSHIP: Colleague
CONTACT DETAILS: 09155075063
RELATIONSHIP: Colleague
CONTACT DETAILS: 090997409948
RELATIONSHIP: TEAM LEADER
CONTACT DETAILS: 09770289991
RELATIONSHIP: QUALITY ASSURANCE MANAGER
CONTACT DETAILS: 09097333490
RELATIONSHIP: Colleague
CONTACT DETAILS: 09365614254

Rev 07.09.2020
AUTHORIZATION

I hereby declare that all information provided in this form are true to the best of my knowledge and that any falsified or
malicious information in this application will be sufficient grounds for withdrawal of offer (if applicant) or dismissal (if
employed) upon discovery. I also confirm that all the personal information of other individuals I provided in this form
are provided with their knowledge and consent, and that I undertake to be responsible to them for my disclosure of
their information to Concentrix.

I authorize Concentrix, its agents, representatives and/or third party providers to verify and confirm any and all
information pertinent to my educational, employment and personal background and history, and is not limited to the
information provided in this form ("Purpose"), with my previous employers, school and other relevant individuals.

I affirm and consent to the disclosure and sharing of my personal information and sensitive personal information,
to Concentrix, its agents, representatives and/or third -party providers, for the said Purpose.
I hereby release, discharge and hold free and harmless, Concentrix , its agents, representatives and/or third
party providers, and the disclosing individual and/or entity, who holds and controls my personal information, with
regard to any above-mentioned sharing, disclosure and processing of my personal information and sensitive
personal information.
I am executing this form and providing my consent, willingly and voluntarily, without compulsion and
intimidation from the company

PRINTED NAME AND SIGNATURE: DATE: 09/04/2020

DIAZ, YANICE COLEEN B.

Rev 07.09.2020