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APPLICATION FORM PICTURE

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1. PERSONAL DATA
SURNAME Ragual GIVEN NAME Jerome MIDDLE NAME Manansala

ADDRESS 227 ibuna st. Brgy. Onse SanJuan City

DATE OF BIRTH(YMD) AGE SEX PLACE OF BIRTH TEL. NO.

1996/05/07 24 Male Pasig city 77440278

CIVIL STATUS married NO. OF CHILDREN 1 RELIGION MOBILE NO.

Roman catholic 09151117636
PASSPORT NO. P9121975A NATIONALITY FILIPINO HEIGHT (CM) BLOOD TYPE
154
PLACE ISSUED megamall DATE ISSUED DATE EXPIRES WEIGHT (KGS) RIGHT HANDED ✅
Oct 11,2018 Oct 10,2028 85 LEFT HANDED 

YES NO NORMAL ABNORMAL FARSIGHTED NEARSIGHTED ASTIGMATISM

COLOR BLIND EYESIGHT

2. EDUCATION BACKGROUND
FROM TO
SCHOOL / INSTITUTE MAJOR GRADUATE
(D/M/Y) (D/M/Y)
COLLEGE / UNIVERSITY Yes No
 
VOCATIONAL / TECHNICAL: Yes No
 
HIGH SCHOOL:rizal high school 05/04/09 03/15/13 Yes No
✅ 
ELEMENTARY:caniogan elementary school 05/06/03 03/15/09

3. WORK EXPERIENCE (LOCAL & ABROAD)

FROM TO POSITIO PRODUC REASON FOR LEAVING
COMPANY LOCATION SALARY
(D/M/Y) (D/M/Y) N T
A.Mother spice Quezon city 19/02/19 PRESENT Itchen Japanesse 15000 Present
food corp staff
B.shibuya tosuto Sanjuan city 06/11/17 15/02/19 Line cook Japanesse 15000 Resigned
corporation

C.ACA GOUP OF Pasig city 09/2016 09/2017 Line cook Western 15000 Store close
COMPANIES

4. DOCUMENTS HELD (check the box)

A. PASSPORT ✅
B. NBI ✅
C. BIRTH CERTIFICATE ✅
D. DIPLOMA ✅
E. UMID ID. ✅
F. TIN NO. ✅

PC PROGRAM KNOWLEDGE EQUIPMENTS/MACHINES OTHER SKILLS

TOOLS USED
OPERATED
REFERENCES

1. Complete Name:lovella peralta

Contact No:
Email:

2. Complete Name:gemifer zari ragual

Contact No:
Email:

In case of Emergency:( 2 Member)

Name of Family Member:gemifer zari ragual
Relationship:wife
Address:227. IBUNA ST BRGY INSE SANJUAN CITY
Contact No.: 09276272326

Name of Family Member:julieta ragual

Relationship:mother
Address:124 e pagasa st caniogan pasig city
Contact No.:

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PLEASE ANSWER THE FOLLOWING QUESTIONS TRUTHFULLY

1. Primary reason why you want to work in Taiwan?__________________________to earn more money____________________

2. Any relatives/friends in Taiwan?  Yes ✅No If yes where?_____________________________________

3. Do you smoke? Yes ✅No. Do you drink?  Yes No. If yes, how often?_______________________

4. Do you eat __yes_____meatyesfish?, or ___yesvegetables? Are you vegetarian? _____ ✅_ No _____ Yes

5. Spoken language: ✅ English ✅ Filipino  Chinese (Pls. specify)_______________ Other language ___________________

6. Religion and Belief: ________roman catholic_________please rate your sanctity (5 as the strong believer): 1  2 3 4
✅5

7. Do you have tattoo?  Yes ✅ No If yes which part? __________________________________________________________

8. Do you agree not to use your mobile phone during work hours? ✅Yes No

9. Are you willing to work for extended hours? ✅ Yes No

10. Are you willing to work on a night shift? ✅Yes No.

lf No, please state your reason _____________________________________________________________________________

11. How do you rate your working attitude (1-5) 5 is the highest (very hard working)  1  2 3 4 ✅5

12. If you have children, who will take care of your children when you leave for Taiwan? __my wife_______________________

13. Will it be acceptable to you if you will not be able to attend church on Sunday? _______________yes_________________________

14. What will you do if you miss your family?_____________call them__________________

15. . If selected, how will you provide for your expenses? _____________________________
16. 16. Please indicate if you have any of the following. symptons:
Heart Ailment _____ Epilepsy _____ Asthma _____ Hypertension _____ Mental Disorder _____ Stomach Ailment _____
Others (Pls. specify) __________________ Previous Surgery / Operations ______________________ Any Previous Injury
______________________