REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF ENERGY
Renewable Energy Management Bureau
Geothermal Energy Management Division (GEMD)
Fort Bonifacio, Taguig, Metro Manila

APPLICATION FOR SAFETY OFFICER’S PERMIT

Name : Noel M. Granada Sex : Male

Residence : Brgy. Tongonan Ormoc City, Leyte
Date of Birth : October 29, 1984 Place of Birth : Ormoc City
Citizenship : Filipino Civil Status : Married
Employer : UPC Address : Ormoc City
Designation : Safety Officer ACR. No. :

Educational Attainment:
Date Attended Degree Completed

Elementary : Ormoc City Central School 1991-1997 Graduate

Secondary : New Ormoc City National High 1999-2003 Graduate
School
Vocational : N/A
College : Eastern Visayas State 2003-2007 Bachelor of Teaching
University Technology and
Home Economics
Post-graduate :

Work Experience: Safety Officer

Name & Address of Employer : United Perlite Corporation

Brgy. San Pablo, Ormoc City
Inclusive Date : January 2013- Present Last Position Held : Safety Officer
Training/ Seminars : Construction Safety Inclusive Date : January 21-25, 2013
Training
Basic Safety Orientation Course July 17-19, 2019

Skills/ Special Qualifications :

Government Examination Passed :

IN WITNESS WHEREOF, I hereby execute this Renewal Application of my Safety Officer's

Permit for year 2022 this 8th day of April 2022.

Noel M. Granada
Affiant
 ACKNOWLEDGEMENT

)
) s. s.

BEFORE ME, on this ______________ at ________________, personally appeared

Name Driver's License / SSS Number Date and Place Issued

Noel M. Granada H03-15-001075 Nov. 27, 2017-Ormoc City

Leyte
06-2737790-9 2008-Ormoc City, Leyte

Known to me and to me known to be the same person who executed the foregoing Safety Officer's
Permit Renewal Application for 2022 and who acknowledged to me that the same is the true and
voluntary act and deed.

WITNESS MY HAND AND SEAL at the date and place herein above mentioned,

NOTARY PUBLIC

Doc. No. _________:

Page No. _________:
Book No. _________:
Series of _________: