PLT COLLEGE, INC.

Bayombong, Nueva Vizcaya

RECRUITMENT FORM

Name of Recruit: BURHAN OMAR HALIM________________________________ Sex: (✅ )

Male ( ) Female
Preferred Course: BS NURSING________ Why: because I wanted to do something in
my career and make challenging, interesting and make difference in peoples live daily the nursing
profession you deal with the difference aspect of patient care that is what I wanted
too._____________________

H.S. Graduated From: LUUK NATIONAL HIGH SCHOOL

_______________________________________________________________
 Address bulaghaw capual luuk sulu
______________________________________________________

Civil Status: ( ✅ Single ( ) Married ( ) Widow

If Married, Name of Spouse: _________________________________________________________

Date of Birth: june 6 1983____________________________ Place of Birth:bulaghaw capual luuk sulu
_____________________________
Dialect/Language Spoken: arabic, tagalog english and tausog__________________ Religion:
islam_________________________________
Person who Recommended you: ______________________________________________________

BURHAN OMA HALIM

_____________________________
Signature over Printed Name

Recruited By: ____________________________ _____________Course/Year: __________________

Home Address: _____________________________________________________________________
Position: (Pls. Check) ( ) PLT College Inc. Student
( ) Faculty Member
( ) Staff
( ) Others (Pls. specify) ____________________________________
Date of Birth: _______________ Place of Birth: ___________________________________________ \
Age: ______________________ Sex: ( ) Male Civil Status: ( ) Single
( ) Female ( ) Married
( ) Widow

How are you related to the recruit?

( ) Neighbor ( ) Friend ( ) Relatives ( ) Brother/Sister
( ) Others (Pls. specify) ______________________________

 ____________________________
Signature over Printed Name

Attested by:

_________________________
Admission Officer