Employment Application Form

- Please fill out the fields legibly/printed. Date of Application: 11/08/2022

- Use the back sheet if necessary. Applying for the position of: FIELD PERSONNEL

- All information will be treated with utmost confidentiality.

- Write N/A if information if “Not Applicable”. Source of Application:

- Use black ink to fill out this form,

Personal Information

First Name Middle Name Last Name Nickname Religion

BENJIE GLORIA PAUD BEMBOY ROMAN CATHOLIC

Contact Number Email Address Facebook Account Gender Date of Birth

09484067714 paud_benjie@yahoo.com Benjie Coralde Gloria Paud MALE 02/26/1991

Marital Status SSS No. Philhealth No. Pagibig No. TIN No

MARRIED 02-2486063-1 08-050938889-3 1210-0519-8209 280-241-889-000.

Present Complete Address Since when

PUROK NO. 3 BRGY. COLETO BISLIG CITY SURIGAO DEL SUR JULY 7 2021

Present Complete Address Since when

PUROK NO. 3 BRGY. COLETO BISLIG CITY SURIGAO DEL SUR FEB. 26 1991

Work History (List of all work experience)

Company Name & Address Position Start and End Date Reason for Leaving Contact No.

Cosmetique Asia Corporation Production Worker Oct. 20, 2019 to March End of contract 424 6831
18,2021
(Tanzang Luma IV Imus City
Cavite)

Alfamart Dist. Center WAREHOUSE Personnel January 10 2020 to August End of contract 8441-4401
Imus( Caishen Agency) #62 17 2020
11th Ave. Murphy Cubao
All representations in the application form are true and correct and in the event any of them is found to be false, this appointment may be reconsidered, even voided. Any misrepresentation in the
application form shall be considered as fraud and shall result in immediate termination if the applicant is employed by the company.
Quezon City

Liwayway Marketing Production Worker September 12,2011 to Dec. Umuwe ng Province 0997 615 3314
Corporation (Oneimus 30,2019
Agency) Brgy. Anabu 1-D
lares bldg. Imus City Cavite

Character References (Former immediate Supervisor / Former professor)

Complete Name Position Company Name & Address Contact No.

Educational Background

Elementary / Address Year Graduated

Brgy. Coleto Bislig City Surigao del Sur 2003

High School / Address Year Graduated

Bislig City Surigao del Sur 2007

College / Address Year Graduated

Course

If undergraduate, please indicate reason and year attended

I hereby know and understand that as part of the Recruitment process, I shall be subjected to a Background Check commissioned by CCSI. Hence, I hereby authorize CCSI and or its authorized
representative to confirm and verify information/s stated above prior to employment, including matters of conduct/behavior, ability/ reputation, education, family, and as well as my financial and credit
standing. I also authorize and request each person and firm referred in my application form to give such information.

BENJIE G. PAUD 11/08/2022

Candidate’s Name/Signature/Date

All representations in the application form are true and correct and in the event any of them is found to be false, this appointment may be reconsidered, even voided. Any misrepresentation in the
application form shall be considered as fraud and shall result in immediate termination if the applicant is employed by the company.