Job Application Form

Highly Confidential
JOB APPLICATION FORM

RECRUITER 10/05/2021
Position Applied For Date Filed (MM/DD/YYYY)
PERSONAL INFORMATION
Please provide all information in print

Last Name First Name Middle Name Suffix
SERRANO KATRINA BAGBAGAY
KATRINA
Maiden Name / Other Name Date of Birth (MM/DD/YYYY) Sex Civil Status
10/27/1991 FEMALE SINGLE
Nationality Contact No. Best Time to Call
FILIPINO 09196303684 8AM TO 5PM
Email Address
serrano.katrina@yahoo.com
ADDRESSES for the last 7 years
Number / Street / Village

82
Barangay State / City Province
ALITAYA MANGALDAN PANGASINAN
Country Postal Code Years of Stay (MM/YYYY)
PHILIPPINES 2432 From 10/1991 To PRESENT
From To
From To
Vanguard Screening Solutions, Inc.

VSSI-ISMS-OPS-Job Application Form v1.0 10F The Belvedere Tower, 15 San Miguel Ave
Ortigas Center, Brgy. San Antonio, Pasig City, Philippines 1605
+632 7621 7435 | Fax: +632 8857 2312 | www.vanguardscreen.com
Highly Confidential
EDUCATIONAL BACKGROUND
Highest Completed Education Details (Please Do Not Fill Pursuing Education)
Name of Institution
UNIVERSITY OF PANGASINAN PHINMA EDUCATION NETWORK
Number / Street / Village State / City / Province Country Postal Code
ARELLANO ST. DOWNTOWN DIST DAGUPAN CITY, PANGASINAN PHILIPPINES 2400
Name in School Records
KATRINAB. SERRANO
Educational Attainment (Post-Graduate / College / Diploma / Vocational / Senior HS / High School)
BACHELOR
Dates Attended (MM/DD/YYYY)
From 07/2008 To 03/2012
Date of Graduation (MM/DD/YYYY) Course of Study

03/31/2012 BACHELOR OF SCIENCE IN NURSING
Honors / Awards Received Student No.
08-1859
Professor / Teacher’s Name Contact No. Best Time to Call
PROFESSIONAL QUALIFICATIONS/MEMBERSHIPS
List information according to your most recent professional license / certification
Date of Examination /
Civil Service / R.A. 1080 Place of Examination / Date of Validity
Conferment License Number
(Board / Bar) Conferment (MM/DD/YYYY)
(MM/DD/YYYY)
NURSING LICENSURE EXAMINATION

06/2012 0769605
DAGUPAN CITY PANGASINAN 10/27/2024

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EMPLOYMENT HISTORY
List information according to your most recent employer for the last 5 years
Name of Company Contact No. / Email ID: Alternative Contact No. / Email ID: Employee ID No.
If employed through an agency, kindly indicate the name and contact information of the agency:
Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________
Status of Employment
✔
Regular Contractual Probationary Seasonal / On-Call
Dates of Employment (MM/DD/YYYY)
From To (for currently employed, kindly indicate last working day)
Most Recent Job Title Department
Can we contact your current employer? (Kindly indicate N/A if not applicable)
Yes No If No, please indicate the date of availability: ________________________
Reason for Leaving: Salary / Financial Probity (if applicable to verify the credit check)
Job Responsibilities:

Highly Confidential
Name of Company Contact No. Alternative Contact No. / Email Employee ID No.
ID:
From To
Name of Company Contact No. Alternative Contact No. / Email ID: Employee ID No.
From To

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PROFESSIONAL REFERENCES
Name Contact No. Other Contact No. / Email Address
Employer Job Title
Relation / Affiliation Best Time to Call
Employer Job Title
Employer Job Title
CHARACTER/PERSONAL REFERENCES

MARCEL JOYCE CAPILE 09776740538 mjcapile_29@yahoo.com
Employer Job Title
HCL TECHNOLOGIES PHILS INC. HR EXECUTIVE
FRIEND 3PM ONWARDS

RUBY ANNE V. CORPUZ 09271457890 arrey.corpuz@gmail.com
Employer Job Title
CALASIAO MUNICIPAL HEALTH OFFICE ISOLATION NURSE
8AM TO 5PM
COLLEGE FRIEND

FR. FRANCISCO M. VARGAS, CM
09985368945
Employer Job Title
CONGREGATION OF THE MISSION PHILIPPINES SPIRITUAL DIRECTOR
FORMER SPIRITUAL DIRECTOR OF YLAC 8AM TO 5PM

Highly Confidential

Highly Confidential
BACKGROUND SCREENING CONSENT

I declare that the information I have provided in the Job Application Form, and in any submitted and/or attached documents,
is true and complete to the best of my knowledge and belief, and that I have answered the questions fully and accurately.
I understand that my pre-employment background screening will include any or all of the following checks:
Any or all of the following will be checked:
 Address Check  Financial Probity

 References Check  Basic Criminality and/or International criminal
 Eligibility to Work background check via jurisdictional court data
 Identity Check  Media Search
 Employment/Education History  Sanction List
 Professional Qualifications/Memberships  Directorship Search
I authorize Vanguard Screening Solutions Inc., as the data processor, an independent agent acting on behalf of my prospective
employer, as the data controller, to verify information presented in my Job Application Form, in any submitted and/or attached
documents, which may include personal and sensitive information for the purposes of compliance with the Philippine Data
Protection Act of 2012 (DPA) and/or the data protection legislation relevant to another country, as applicable. I understand
and agree that, where my personal history required background verifications to be carried out in countries where I have worked
and/or resided, in respect of my employment or education or residence, my data may be sent and processed in those relevant
countries and be governed by applicable data protection legislation which is relevant to the country specified.
I also authorize Vanguard Screening Solutions Inc. to (a) verify my academic/professional qualifications (and for educational
establishments to release information) as well as my employment, including my current employer; (b) contact the appropriate
in-country government departments or agencies to confirm periods of unemployment, if applicable, and to access my personal
online SSS account to check my records upon instruction of my employer; (c) contact the Identity and Passport Service, if
required; (d) perform an international criminal records check (as appropriate); and (e) receive and copy the results of the
checks at their office addresses and communicate the results to my prospective employer. I understand that the results of my
screening will be communicated by Vanguard Screening Solutions Inc. to my prospective employer who in turn may keep a
copy on my personnel file. I understand and accept that Vanguard Screening Solutions Inc. may contact me and my referees
by telephone, email or mail for the purposes set out above. I confirm that my consent is explicit, fully informed and freely given
for the purposes of the background verifications stated above.
Signature : ______________________________
KATRINA BAGBAGAY SERRANO
Full Name : ______________________________
Maiden Name or Other Name : ______________________________

10/05/2021
Date : ______________________________


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Highly Confidential

JOB APPLICATION FORM

Position Applied For Date Filed (MM/DD/YYYY)

Please provide all information in print

ADDRESSES for the last 7 years

Number / Street / Village

PHILIPPINES 2432 From 10/1991 To PRESENT

Number / Street / Village

Barangay State / City Province

Country Postal Code Years of Stay (MM/YYYY)

Number / Street / Village

Barangay State / City Province

Country Postal Code Years of Stay (MM/YYYY)

Vanguard Screening Solutions, Inc.

Highest Completed Education Details (Please Do Not Fill Pursuing Education)

From 07/2008 To 03/2012

Date of Graduation (MM/DD/YYYY) Course of Study

List information according to your most recent professional license / certification

NURSING LICENSURE EXAMINATION

Vanguard Screening Solutions, Inc.

Number / Street / Village State / City / Province Country Postal Code

Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________

Dates of Employment (MM/DD/YYYY)

From To (for currently employed, kindly indicate last working day)

Most Recent Job Title Department

Yes No If No, please indicate the date of availability: ________________________

Vanguard Screening Solutions, Inc.

Number / Street / Village State / City / Province Country Postal Code

Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________

Regular Contractual Probationary Seasonal / On-Call

Dates of Employment (MM/DD/YYYY)

Most Recent Job Title Department

Yes No If No, please indicate the date of availability: ________________________

Number / Street / Village State / City / Province Country Postal Code

Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________

Regular Contractual Probationary Seasonal / On-Call

Dates of Employment (MM/DD/YYYY)

Most Recent Job Title Department

Yes No If No, please indicate the date of availability: ________________________

Vanguard Screening Solutions, Inc.

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Name Contact No. Other Contact No. / Email Address

Name Contact No. Other Contact No. / Email Address

Vanguard Screening Solutions, Inc.

Vanguard Screening Solutions, Inc.

BACKGROUND SCREENING CONSENT

Any or all of the following will be checked:

 Address Check  Financial Probity

Maiden Name or Other Name : ______________________________

Vanguard Screening Solutions, Inc.

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