Republic of the Philippines

Department of Agriculture
Philippine Center for Postharvest Development and Mechanization
Science City of Muñoz, Nueva Ecija, Philippines
www.philmech.gov.ph
APPLICATION FOR EMPLOYMENT

Date received: _______________ By: _____________________ Recommended by: ________________

POSITION APPLIED FOR: _________________________

NAME: _____________________________________________________________________________
MAIDEN NAME (if applicable) LAST NAME FIRST NAME MIDDLE NAME

PERSONAL INFORMATION

Residential __________________________________________________________________________
Address Street No. Street Barangay/District/Subdivision Municipality/ City

__________________________________________________________________________
Province Zip Code
Provincial __________________________________________________________________________
Address: Street No. Street Barangay/District/Subdivision Municipality/ City

__________________________________________________________________________
Province Zip Code

Mobile Phone No.: Telephone No.: Email Address:

Date of Birth: Age: Place of Birth:
MM / D/D / YY (As of last birthday) (Municipality/City, Province)
Gender: Blood Type: Civil Status:

IF MARRIED, Name and Age of Spouse:

Occupation, Place of Employment of Spouse:
Name & Age of Living Children:
Person to Contact in Case of Emergency: Contact No.:

QUALIFICATION DATA

ACADEMIC RECORD: EARNED OR HIGHEST

EDUCAT’L LEVEL DEGREE /COURSE YR. GRADUATED SCHOOL

Postgraduate:
College:
Vocational:
High school:
Elementary:
SCHOLASTIC ACHIVEMENTS:

AWARDS, COMMENDATIONS, MEDAL, ETC. RECEIVED:

NATURE AWARDED BY DATE AWARDED

CIVIL SERVICE/ LICENSURE EXAMINATION TAKEN:

TITLE OF EXAMINATION RATING DATE PLACE OF EXAMINATION

___________________________ __________ __________ __________________________
___________________________ __________ __________ __________________________
___________________________ __________ __________ __________________________

PHilMech-AD-F-005 Rev 00 (12.05.17)

 Republic of the Philippines
Department of Agriculture
Philippine Center for Postharvest Development and Mechanization
Science City of Muñoz, Nueva Ecija, Philippines
www.philmech.gov.ph
APPLICATION FOR EMPLOYMENT

TRAINING RECORD: (IN-SERVICE TRAINING, SEMINAR, SPECIAL STUDIES, ETC)

TITLE NO. OF PERIOD OF CONDUCTED BY

HOURS TRAINING
______________________ _______ _______________ _________________________
______________________ _______ _______________ _________________________
______________________ _______ _______________ _________________________
______________________ _______ _______________ _________________________

EMPLOYMENT RECORD:

DATE EMPLOYER POSITION SALARY REASON FOR

FROM TO SEPARATION
__________________ ________________ ______________ ___________ ________________
__________________ ________________ ______________ ___________ ________________
__________________ ________________ ______________ ___________ ________________
__________________ ________________ ______________ ___________ ________________
SPECIAL SKILLS: (Typing, computer operation, illustration, driving, etc.)

SKILL HOW ACQUIRED LEVEL OF PROFICIENCY

MEMBERSHIP IN ORGANIZATION(S)

NAME OF ORGANIZATION POSITION LOCATION

REFERENCES
Name three(3) persons who know you well and can make an objective assessment of your abilities and skills essential for graduate work e.g.
former professor, present superior or employer etc.

NAME POSITION/ADDRESS CONTACT NUMBER

PLEASE ANSWER HONESTLY & BRIEFLY:

1. Are you related by consanguinity or affinity to any of the employees of PHilMech?

If yes, Please indicate name and degree of relationship
2. Have you ever been convicted of any crime, dismissed from employment, forced to resign or otherwise
disciplined as a result of administrative case? If so, give particulars:
3. Are you willing to travel and/or be assigned in the province?
4. How much minimum salary are you willing to accept?
5. When can you start working with us?

I hereby certify that the answers given above are true and correct to the best of my knowledge. I authorize the
PHilMech to conduct background check to verify the truthfulness of my statements.

SIGNATURE OF APPLICANT
Residence Certificate No: __________________
Issued at _____________ on ________________
PHilMech-AD-F-005 Rev 00 (12.05.17)