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

Position Applied Sourced from / by

A. Personal Details
Name (First, Middle, Last)
Nickname Birthdate Gender Age Height Weight
Religion Civil Status # of Children

B. Contact Details
Current Address
Permanent Address
Mobile Number E-mail Address

C. Education
School Completed Yes No
Course / Degree Date Completed
Type Elementary High School Vocational / Associate Bachelor’s Post Graduate

D. Condition Of Health
1. Do you smoke? Yes No Occasionally
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. Are you amenable to work onsite? Yes No
6. In 2-3 sentences, tell us about what you are most proud of about yourself?

7. How have you been coping with the turn of events brought about by Covid 19?

8. Why are you applying to Healthy Options / Bow&Wow / Wine Story / Planet Grapes?

9. What other companies and positions are you considering right now?

10. 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.

11. If hired, how soon can you start work at Healthy Options?

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

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

Printed Name Signature Date