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  • Application Form Survey

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    Jake Madz
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    This document is an applicant source and medical history form for employment. It asks the applicant to provide their name, position applied for, and how they heard about the job opening. It then asks a series of yes or no medical and legal history questions, including about tattoos, union membership, vices, smoking, drinking, allergies, illnesses, surgeries, medications, prohibited drugs, loans, and physical defects. It warns that any falsification or omission could result in dismissal.

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    Application Form Survey

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    This document is an applicant source and medical history form for employment. It asks the applicant to provide their name, position applied for, and how they heard about the job opening. It then asks a series of yes or no medical and legal history questions, including about tattoos, union membership, vices, smoking, drinking, allergies, illnesses, surgeries, medications, prohibited drugs, loans, and physical defects. It warns that any falsification or omission could result in dismissal.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views1 page

    Application Form Survey

    Uploaded by

    Jake Madz
    This document is an applicant source and medical history form for employment. It asks the applicant to provide their name, position applied for, and how they heard about the job opening. It then asks a series of yes or no medical and legal history questions, including about tattoos, union membership, vices, smoking, drinking, allergies, illnesses, surgeries, medications, prohibited drugs, loans, and physical defects. It warns that any falsification or omission could result in dismissal.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Name: ______________________________________ Position: __________________________

    APPLICANT SOURCE: Please check the applicable box.


    Referral (H99, Red Hotel, Affiliate Employees)
    Online Job Sourcing (Job Street, Indeed, Linked-In, Best Jobs, Jora, Fast Jobs, etc.)
    Social Media: Facebook
    Others: Walk-Ins (Word-of-Mouth, Flyers, Poster)
    Please specify: ________________________

    Instructions: For Question 1-14, answer with YES or NO.

    ______ 1. Do you have body tattoo? If yes, please specify. ___________________

    ______ 2. Have you been a member of any labor union?

    ______ 3. Do you have any vices? If yes, please specify.

    ______ 4. Do you smoke?

    ______ 5. Do you drink alcohol?

    ______ 6. Do you have allergy? If yes, please specify.

    ______ 7. Do you have asthma?

    ______ 8. Have you been involved in any crime?

    ______ 9. Did you have any surgery? If yes, please specify.

    ______ 10. Are you on medication for any illness before? If yes, please specify.

    ______ 11. Did you have any serious illness before? If yes, please specify.

    ______ 12. Did you take prohibited drugs?

    ______ 13. Do you have any pending loan in SSS/PAG-IBIG?

    ______ 14. Do you have physical defect?

    ______ 15. Do you have previous, pending or on-going case in DOLE, TRIAL COURT on your previous
    employer?

    This form is part of the original employment application. Any falsification or omission will be
    grounds for dismissal.

    Signature over Printed Name Date

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