A P P L I C AT I O N F O R M

Position Applied Customer Service Sourced from / by

A. Personal Details
Name (First, Middle, Last) Kesia Jean V. Sandoval
Nickname Kesia Birthdate December 29, 1998 Gender Female Age 22 Height 5'5 Weight 57
Religion Catholic Civil Status Single # of Children

B. Contact Details
Current Address Luyang, Guiljungan, Cauayan, Negros Occidental

Permanent Address Luyang, Guiljungan, Cauayan, Negros Occidental

Mobile Number 09774411645 E-mail Address kesiajeansandoval@gmail.com

C. Education
School Central Philippines State University Completed Yes No
Course / Degree Bachelor of Elementary Education Major in General Education Date Completed April 08, 2019

Type Elementary    High School    Vocational / Associate    Bachelor’s    Post Graduate

D. Condition Of Health
1. Do you smoke? Yes No Occasionally
2. Have you been diagnosed to have any of the ff? Please Check.   Allergies  Hypertension  PTB  Scoliosis  Allergies  Skin Disorder
Remarks
3. Have you ever been hospitalized? Yes No Date Condition

E. Interests, Preferences, And Expectations

4. Do you have any pets? Yes No # of Dogs # of Cats
5. Do you drink wine? Yes No How extensive is your wine knowledge?
6. What other companies and positions are you considering right now?
NONE

7. Are you related to anyone employed at Healthy Options, Bow&Wow, Wine Story or Planet Grapes? If yes, please write down the name/s of relative and
  your relation.
Ms. Jezel Reyes Vargas - 2nd cousin

8. How much is your expected salary? 18, 000 monthly 9. If hired, how soon can you start work at Healthy Options? After 2 months

F. Other Questions
10. Do you have any criminal record?  Yes No 11. Do you have any pending cases against you?  Yes No

I have fully declared the above information as true and correct to the best of my knowledge. I understand that if it was discovered later that I have misrepresented myself,
withheld information, or misled Healthy Options Corporation, it may be used as grounds for termination and possible loss of all my accrued benefits from the Company.

I authorize Healthy Options to ask and inquire from my schools, present/previous employers or references any and all information which maybe sought by them including
my work habits, character and skills.

I understand that Healthy Options shall also keep confidential any information that I share with the Company for the purpose of my application.

Printed Name Signature Date