5/2/22, 10:13 AM Updated: Work From Home Readiness Assessment for New Hires

Updated: Work From Home Readiness

Assessment for New Hires
In light of the State of Public Health Emergency issued by the Department of Health due to the
increase in number of confirmed COVID19 cases, we would like to assess your readiness for a
work from home set up.

This self checklist is to be completed by employees intending to work from home. Your
submission will be carefully assessed by EMAPTA IT Security and Human Resources Department
and in coordination with your client, we will determine if the home work area is appropriate to
meet standards.

Please fill in the details below

1. Complete Name: *

Natalia C. Hernandez

2. Exact Delivery Address for IT Assets: *

Felix Galura st., San Vicente, Bacolor, Pampanga

3. Transportify PIN Location (If available): *

Felix Galura st., San Vicente, Bacolor, Pampanga

4. Primary Contact No.: *

09176775101

5. Alternate Contact No.: *

09496363699

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6. Authorized Receivers Complete Name: *

Natalia C. Hernandez or Irene C. Hernandez

7. Work Schedule: *

6AM-3PM

8. Start Date: *

May 10, 2022

9. E-mail Address: *

hernandez.nath1821@gmail.com

Internet Connectivity

10. Do you have an internet connection at home? (Pocket wifi and wireless hotspot is
not allowed)

If your answer is NO, please proceed to the next questions/sections and select or
write NA. *

Yes

No

11. What is your internet speed?

If unsure, you can check your internet speed via speedtest.net or you can
download the app using your mobile phone *

Less than 5 mpbs

6 - 10 mpbs

11 - 20 mbps

21 - 30 mbps

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31 - 40 mbps

40 mbps and up

NA

12. How many internet users do you have at home? *

1-2

3-5

5 and up

NA

13. What is your internet provider? *

Globe

Smart

Pldt

Sky

Converge

Others

NA

Work environment at your home

14. How often do you experience power outage at home? *

Never

Once a week

2 to 3 times a week

More than 3 times a week

NA

15. How often do you experience internet outage at home? *

Never

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5/2/22, 10:13 AM Updated: Work From Home Readiness Assessment for New Hires

Once a week

2 to 3 times a week

More than 3 times a week

NA

16. Does your home environment allows you to work privately, peacefully, and
securely? *

Yes

No

Proof
In completion of this assessment, kindly send the following to wfh.assessment@emapta.com and follow
the file naming convention as instructed:

1. At least TWO photographs, in different angles, of your work area (Lastname_Client_Site_WA)

2. Screenshot of your speedtest result (Lastname_Client_Site_ST)

3. Proof of your internet subscription (Billing statement reflecting your bandwidth and address)
(Lastname_Client_Site_PB)

4. E-mail subject Lastname_Firstname_Client

**You can take a photo of the above instructions for your reference**

Terms and Conditions

17. Should there be any changes with your address after submitting this form and
before your start date, you are expected to inform your recruiter with all the
necessary details needed for delivery.

Agree

Disagree

18. Should your Work-from-home request be approved, you are expected to read,
understand and sign an accountability form, acceptance form and other necessary
documents, as well as Confidentiality agreement to ensure your adherence to our
Data Privacy Protocol for the safety of your workplace and data.

Agree

Disagree

Thank you for answering the Assessment Form!

The EMAPTA IT Security Team will review your assessment and contact you for further questions and to
arrange the next steps. Please note that the ability to Work from Home is dependent on the outcome of

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5/2/22, 10:13 AM Updated: Work From Home Readiness Assessment for New Hires

this assessment, the clients' approval, as well as the acceptance and completion of all necessary
documentation.

Thank you for taking the time to fill this assessment form, we look forward to support you and your
team to have a healthy and safe work environment.

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