REPUBLIC OF THE PHILIPPINES

RKS Form 5 DEPARTMENT OF LABOR AND EMPLOYMENT Page 1 of 5

2009 ______________________________ pages
Field office/Regional Office

Instructions:
1. Accomplish this form in two copies when filling notice of displacement of flexible work arrangements. The
report is considered as dully filled when the complete list of workers affected is made part of the submission.
2. This form should be submitted to the DOLE Field Office 30 calendar days prior to affectivity of
displacement/adoption of flexible work arrangements.
3. Page 1 should contain general information about the establishment and the number of workers affected.
4. Page 2 should enumerate the names of workers affected and their addresses and contact numbers.
5. Total numbers of workers listed should equal the total number of workers affected as reported in this page.
ESTABLISHMENT EMPLOYMENT REPORT
A. Establishment Data:
RW PONCE BUILDERS
Name of Establishment_____________________________________________________________________________
A. MABINI ST.
Floor/Bldg./No./Street/Subdivision_____________________________________________________________________
_________________________________________________________________________________________________
BRGY. POBLACION II, PAGSANJAN
Barangay/City/Municipality___________________________________________________________________________
4008 LAGUNA
Zip Code/Province_________________________________________________GEOCODE 0 4 3 4 1 9 0 0 0
l__I__I__I__I__I__I__I__I__l
CONSTRUCTION (DESIGN & BUILD)
Main Economic Activity(Specify products/goods/services)__________________________________________________
84 4
___________________________________________________________________________ PSIC l__l__l__l__l__l__l
Total Employment: No of Female Workers:
0 3 2 0 2 0 2 0
Date of filling: (mm/dd/yyyy) l__l__l__l__l__l__l__l__l
1.Establishment Status: (please check applicable status)
[ ] Permanent Closure [√] Temporary Closure
[ ] Reduction of Workforce [√] Flexible Work Arrangements
OTH
2. Main reason for Shutdown /Retrenchment of Workers (use code below, select only one):_________________
3. Is the closure/reduction of workforce/flexible work arrangements as a consequence of:
COVID-19 HEALTH CRISIS
[ ] Global Crisis [√] Others (specify)______________________________________________
B. Workers Affected by Displacement /Flexible Work Arrangements
Effectivity Date
Indicator No. of Workers From To
Affected (mm/dd/yyyy) (mm/dd/yyyy)
1. Permanent Terminations
2. Temporary Layoffs
3. Flexible Work Arrangements 84 03/15/2020 04/15/2020
3.1 Rotation of Workers
3.2 Reduced Workhours/Workdays
3.3 Forced Leave
Codes for Main Reason for Shutdown/Retrenchment of Workers:
Economic Reasons Non‐Economic Reasons
LM Cancellation of orders/ CI Competition from PC Project Completion NCL Natural Calamities(fire,
Lack of market/Slump in Imported products AWOL Absence without Leave typhoon, etc.)
Demand UCP Uncompetitive price of LLDA Ceased and Desist Order
LC Lack of capital product NRM Repair/General
HCP High cost of production MR Increase in minimum SM Serious Misconduct Maintenance
R Redundancy wage rate INV Inventory
CMM Change in management/ LRM Lack of raw materials GHN Gross Habitual Neglect FDL Forced Leave
Merger PD Peso devaluation/ RES Resigned
RDS Company reorganization/ appreciation RET Retirement
Downsizing OTH others (specify) CCO Commission of a crime OTHS others
or Offense (please specify)____________
COVID-19 HEALTH CRISIS
_________________________
FUD Fraud

CERTIFICATION
This is to certify as to the accuracy of the data provided in this report.
Name/Signature of Owner/
Company Representative:
Position: OFFICE ENGINEER Fax No.:
Tel. No.: (049) 557-1684 Email Address:
REPUBLIC OF THE PHILIPPINES
RKS Form 5 DEPARTMENT OF LABOR AND EMPLOYMENT Page 2 of 5
2009 ______________________________ Pages
Field office/Regional Office

Instructions: Use additional sheets if necessary following same format.

LIST OF AFFECTED WORKERS BY DISPLACEMENTS/ FLEXIBLE
WORK ARRANGEMENTS
No Name of Worker Address Contact Type of
. (Last Name, First Number/s Displacements/
Name, M.I) Flexible Work
Arrangements
(use code
below)
1. ABAD, RENATO JR. T. BRGY. BALUBAD, LUMBAN, LAGUNA 0965-465-0522 2
2. ABENDANTE, JOSEPH P. BRGY. BAGUMBAYAN, STA. CRUZ, LAGUNA 0936-646-9417 2
3. ABENDANTE, JERICO P. BRGY. SANTISIMA CRUZ, STA. CRUZ, LAGUNA 0955-178-1132 2
4. ABENDANTE, JESUS P. BRGY. STO. ANGEL NORTE, STA. CRUZ, 0955-366-0928 2
LAGUNA
5. ABENDANTE, WILFREDO JR. P. BRGY. PAGSAWITAN, STA. CRUZ, LAGUNA 0997-802-2402 2
6. ALDEA, ANTHONY M. BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766-7580 2
7. ALDEA, LUSANDE BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766-7580 2
8. ALVAREZ, ALVIN S. BRGY. PALASAN, STA. CRUZ, LAGUNA 0926-365-5278 2
9. ARIOLA, ARJAY C. BRGY. SAMPALOC, PAGSANJAN, LAGUNA 0919-745-8881 2
10. BACALSO, JERALD R. BRGY. CAWAYAN, SAN VICENTE, MASBATE 0955-056-3206 2
11. BAJAO, EDWARD T. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0967-610-3279 2
12. BALMAS, ERNESTO JR. N. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0906-694-3284 2
13. BOMBAY, EUGENE P. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0950-143-4649 2
14. CABALQUINTO, MICHAEL N. CABUNGAN, ANDA, PANGASINAN 0917-787-8270 2
15. CABARLES, MARLOU B. SAN VICENTE, MASBATE 0955-056-3206 2
16. CADANO, JHON MARK BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766-7580 2
17. CAMASO, JOSEPH C. BRGY. IMBO, ANDA, PANGASINAN 0949-848-5336 2
18. CAMBEL, FERDIE D. BRGY. SAN JUAN, STA. CRUZ, LAGUNA 0906-144-8006 2
19. CARANDANG, CHERRY JOY C. BRGY. SAMPALOC, PAGSANJAN, LAGUNA 0908-326-4507 2
20. CARANDANG, MICHAEL W. BRGY. SAMPALOC, PAGSANJAN, LAGUNA 0908-254-6639 2
21. CARETERO, CHRISTIAN A. BRGY. IMBO, ANDA, PANGASINAN 0906-157-7421 2
22. CARETERO, DANTE E. BRGY. IMBO, ANDA, PANGASINAN 0906-157-7421 2
23. CARETERO, LIZA E. BRGY. IMBO, ANDA, PANGASINAN 0906-157-7421 2
24. CARILLAGA, JON MICO P. BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766-7580 2
25. CARILLO, RONALD ANDREW BRGY. MAULAWIN, PAGSANJAN, LAGUNA 0933-447-9348 2
O.

Codes for Type of Displacements/Flexible Work Arrangements:

1. Permanent Termination
2. Temporary Layoff
3. Rotation of Workers
4. Reduced Workhours/Workdays
 CERTIFICATION
This is to certify as to the accuracy of the data provided in this report.
Name/Signature of Owner/
Company Representative:
Position: OFFICE ENGINEER ROSE RANNELLEFax No.:
FERNANDEZ
Tel. No.: (049) 557-1684 Email Address: rwp.builders@yahoo.com
REPUBLIC OF THE PHILIPPINES
RKS Form 5 DEPARTMENT OF LABOR AND EMPLOYMENT Page 3 of 5
2009 ______________________________ Pages
Field office/Regional Office

Instructions: Use additional sheets if necessary following same format.

LIST OF AFFECTED WORKERS BY DISPLACEMENTS/ FLEXIBLE
WORK ARRANGEMENTS
No Name of Worker Address Contact Type of
. (Last Name, First Number/s Displacements/
Name, M.I) Flexible Work
Arrangements
(use code below)
26. CASTILLO, DIOSDADO B. BRGY. IMBO, ANDA, PANGASINAN 0908-644- 2
6498
27. CESARIO, RJAY BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
28. CEZALDO, JAYSON D. BRGY. PINAGSANJAN, PAGSANJAN, 0933-447- 2
LAGUNA 9348
29. CORCUERA, MARVIN BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
30. CORDOVA, MARK REY S. BOLINAO, PANGASINAN 0948-373- 2
1932
31. CORDOVA, RONALD BOLINAO, PANGASINAN 0948-373- 2
1932
32. DATOY, VALENTINO BRGY. PALASAN, STA. CRUZ, LAGUNA 0950-783- 2
1824
33. DAVE, ROMEO JR. BRGY. SAMPALOC, PAGSANJAN, LAGUNA 0915-619- 2
2403
34. DE JESUS, NOEL BRGY. HONDAGUA, LOPEZ, QUEZON 0950-783- 2
1824
35. DELGADO, JESUS BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
36. DIMASACA, GREGORIO R. BRGY. PALASAN, STA. CRUZ, LAGUNA 0950-783- 2
1824
37. DIMASACA, JOHN LOYD G. BRGY. PALASAN, STA. CRUZ, LAGUNA 0927-520- 2
3699
38. DIMASACA, MARIO JR. S. BRGY. PALASAN, STA. CRUZ, LAGUNA 0935-575- 2
7560
39. DIMASACA, MARWIN S. BRGY. PALASAN, STA. CRUZ, LAGUNA 0955-623- 2
7996
40. DIMASACA, PANFILO R. BRGY. PALASAN, STA. CRUZ, LAGUNA 0965-937- 2
4335
41. DIZON, JOHN LLOYD L. BRGY. BAGUMBAYAN, STA. CRUZ, LAGUNA 0946-092- 2
1307
42. DULA, RODRIGO BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
43. DUMALAGAN, ALEJANDRO JR. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0939-897- 2
G. 6638
44. EDEZA, ARJAY P. BRGY. MAULAWIN, PAGSANJAN, LAGUNA 0933-447- 2
9348
45. ESGUERRA, ANDREW BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
46. FABRICIO, RONNEL A. BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
47. FERNANDEZ, RONEL M. BRGY. STO. ANGEL SUR, STA. CRUZ, 0921-234- 2
LAGUNA 7248
48. FERNANDEZ, ROSE RANNELLE O. BRGY. STO. ANGEL SUR, STA. CRUZ, 0918-622- 4
LAGUNA 7072
49. FERRARO, JOE BRGY. IMBO, ANDA, PANGASINAN 0906-157- 2
7421
50. FERRARO, JOENIFER BRGY. IMBO, ANDA, PANGASINAN 0906-157- 2
7421

Codes for Type of Displacements/Flexible Work Arrangements:

1. Permanent Termination
2. Temporary Layoff
3. Rotation of Workers
4. Reduced Workhours/Workdays

This is to certify as to the accuracy of the data provided in this report.
Name/Signature of Owner/
Company Representative:
Position: OFFICE ENGINEER
Tel. No.: (049) 557-1684
RKS Form 5
2009
CERTIFICATION
ROSE RANNELLEFax No.:
FERNANDEZ
Email Address: rwp.builders@yahoo.com
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF LABOR AND EMPLOYMENT Page 4 of 5
______________________________ Pages
Field office/Regional Office

Instructions: Use additional sheets if necessary following same format.

LIST OF AFFECTED WORKERS BY DISPLACEMENTS/ FLEXIBLE
WORK ARRANGEMENTS
No Name of Worker Address Contact Type of
. (Last Name, First Number/s Displacements/
Name, M.I) Flexible Work
Arrangements
(use code below)
51. HUIT, ROMULO C. BRGY. IMBO, ANDA, PANGASINAN 0920-356- 2
5861
52. JUEGO, BENJIE 0930-754- 2
BRGY. HONDAGUA, LOPEZ, QUEZON
7066
53. LATORRE, ERIC LIPA CITY, BATANGAS 0920-380- 2
5087
54. MAGDALENA, MENANDRO BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
55. MARTINEZ, REYZEL S. BRGY. PALASAN, STA. CRUZ, LAGUNA 0955-879- 2
1724
56. MATIAS, WARREN BRGY. SANTA CLARA SUR, PILA, LAGUNA 0923-186- 2
7589
57. MENDOZA, ALBERTO BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
58. MENDOZA, WILSON BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
59. MENESES, JOANNA MARIE L. BRGY. PAGSAWITAN, STA. CRUZ, LAGUNA 0955-558- 4
9416
60. MERCADO, JUDE VENSON V. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0906-156- 2
6123
61. MOLERA, RODOLFO S. DAANG BAKAL, PAGSANJAN, LAGUNA 0907-817- 2
4528
62. MONEDA, FERDINAND BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
63. NABOR, MERPHOL BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
64. PADOC, RONIE A. BRGY. IMBO, ANDA, PANGASINAN 0906-157- 2
7421
65. PALOYO, RANDY BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
66. PAMATMAT, JOEY BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
67. PAMATMAT, JOSEPH BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
68. PAMATMAT, REX BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
69. PELONIO, JOSEPH B. BRGY. PALASAN, STA. CRUZ, LAGUNA 0938-931- 2
0767
70. PONCE, RANDY S. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0907-899- 2
5553
71. PONCE, RONNEL R. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0906-219- 2
6932
72. RAMAT, TONTON BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
73. RAMOS, MHARLEY P. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0967-563- 2
4923
74. RIVERA, TEDDY BRGY. PALASAN, STA. CRUZ, LAGUNA 0936-766- 2
7580
75. ROSALES, RAYAN O. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0975-277- 2
3036

Codes for Type of Displacements/Flexible Work Arrangements:

1. Permanent Termination
2. Temporary Layoff
3. Rotation of Workers
4. Reduced Workhours/Workdays

CERTIFICATION
This is to certify as to the accuracy of the data provided in this report.
Name/Signature of Owner/
Company Representative:
Position: OFFICE ENGINEER ROSE RANNELLEFax No.:
FERNANDEZ
(049) 557-1684 rwp.builders@yahoo.com
Tel. No.: Email Address:
REPUBLIC OF THE PHILIPPINES
RKS Form 5 DEPARTMENT OF LABOR AND EMPLOYMENT Page 5 of 5
2009 ______________________________ Pages
Field office/Regional Office

Instructions: Use additional sheets if necessary following same format.

LIST OF AFFECTED WORKERS BY DISPLACEMENTS/ FLEXIBLE
WORK ARRANGEMENTS
No Name of Worker Address Contact Type of
. (Last Name, First Number/s Displacements/
Name, M.I) Flexible Work
Arrangements
(use code below)
76. RULLAN, JOSEPH C. BRGY. IMBO, ANDA, PANGASINAN 0930-629- 2
3754
77. SAN JOSE, ABRIAN BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0912-174- 2
7663
78. SANDOVAL, REYMART S. BRGY. PALASAN, STA. CRUZ, LAGUNA 0951-776- 2
3650
79. SILVA, ERNIE JR. BRGY. PALASAN, STA. CRUZ, LAGUNA 0955-366- 2
0928
80. VALDEZ, BENJIE ALAMINOS, PANGASINAN 0906-157- 2
7421
81. VILLAMOR, MARK RAVEN L. BRGY. SAN ISIDRO, PAGSANJAN, LAGUNA 0950-203- 2
7943
82. VILLANUEVA HONEYLETH S. BRGY. MAGDAPIO, PAGSANJAN, LAGUNA 0935-912- 4
7169
83. YATCO, GIAN CARLO E. BRGY. MAULAWIN, PAGSANJAN, LAGUNA 0933-447- 2
9348
84. ZULETA, ERWIN BRGY. HONDAGUA, LOPEZ, QUEZON 0950-783- 2
1824

Codes for Type of Displacements/Flexible Work Arrangements:

1. Permanent Termination
2. Temporary Layoff
3. Rotation of Workers
4. Reduced Workhours/Workdays