TECHNOSERVE CO., INC.

An affiliate of
12th Floor, Bank of Makati Building, Ayala Avenue Extension, 1209 Makati City, Philippines
Telephone No.: (632) 8889-9440 Website: www.tcci-jgc.ph

APPLICATION FOR LOCAL EMPLOYMENT Date (MM/DD/YY) May 20, 2022

PERSONAL INFORMATION
Name as per Passport First Name Geraldine Middle Name Panghula Last Name
Permanent Address
Contact Details Home Mobile E- mail Address
Current Address
Date of Birth No. of
Civil Status Religion
(MM/DD/YY) Dependents
Highest Educational Attainment Finished ( Please Year
indicate specific degree/ course for Graduated
College/ Vocational/ Technical)
Have you had your educational certificates authenticated by the DFA? Yes No If yes, when?
CURRENT SITUATION
Position Applied For
Total Years of Experience Domestic Overseas
Earliest Availability Date Notice Period Required
LAST/ CURRENT EMPLOYMENT DETAILS
Currently Employed Yes No Position
Current/ Last Salary Package Employer
Standard Working Hrs. Per Week Last/ Current Employment
Other Allowances, if any Location
Overtime Claim Yes No Overtime Rate
Expected Salary
BASIC HEALTH INFORMATION
Please tick where applicable
1. Do You Have a History of:
No Yes If Yes, please specify
a. Hypertension or Heart Problems
b. Lung Problems (Tuberculosis, Lung Scar, etc.)
c. Eye Problems (Color Blindness, etc.)
d. Communicable / Infectious Diseases
2. Have you had any major Medical Treatment
or Operation in the last 2 years?
3. Have you had any other health issue/s?
COVID- 1 9 VACCINATION STATUS
1. Have you been vaccinated for COVID- 19? Yes No
2. If so, how many doses have been administered? 1 2
3. What is the brand of vaccine?
4. Have you taken the COVID-19 booster shot? Yes No Booster brand of vaccine
CHARACTER REFERENCES
Name:
Company: Contact Number/ s:
Position Title: Email Address:

Name:
Company: Contact Number/ s:
Position Title: Email Address:

Name:
Company: Contact Number/ s:
Position Title: Email Address:

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 COMMENTS, IF ANY

I hereby certify that the information hereunder is correct to the best of my knowledge and understand that falsification of
this information is ground for refusal to hire or, if hired, dismissal.

DATA PRIVACY CONSENT/ AGREEMENT

TCCI is committed to protect the security and privacy of your Personal Data in accordance with Republic Act No. 10173,
also known as the Data Privacy Act of 2 0 1 2 and its Implementing Rules and Regulations.

AUTHORIZATION AND CONSENT

By submitting your personal data to us, you consent to the collection, use and processing of your Personal Data and accept
and agree to be bound by the terms stated in the TCCI Data Privacy Policy ( http: / / tcci- jgc. ph/ data- privacy- policy/ ) . Rest assured
that your Personal Data will not be used and disclosed in a manner not stated in our privacy policy statement.

If you submit this form electronically please tick

the check box as an alternative to signing the form.

Name in Full

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