NEW EMPLOYEE FORM (San Mateo)

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SM City San Mateo, Gen. Luna Ave.
Brgy. Ampid 1, San Mateo Rizal
PHOTO

PERSONAL INFORMATION
LAST NAME: Balbastro  AGE: 24 
 May 2,
FIRST NAME: Neil  BIRTHDAY (mm/dd/yyyy): 1997
Zaragoza
Maternity
MIDDLE NAME: Bautista  BIRTHPLACE: Clinic 
SUFFIX (if any): Jr GENDER: Male
MAIDEN NAME (for married women):   CIVIL STATUS: Single 
CONTACT DETAILS 
Blk 17
PRESENT House # Lt 17 Street/Village Sierra Madre Extension, Montavilla Phase 1
ADDRESS: Brgy. Burgos
City Montalban Prov. Rizal Zip Code
House # 052 Street/Village
PERMANENT
Brgy. H-Romero
ADDRESS:
City Zaragoza Prov. Nueva Ecija Zip Code
MOBILE 1 #: 09615686387 MOBILE 2 # N/A
ACTIVE EMAIL ADDRESS: Neilbalbastro1@gmail.com  HOME PHONE #: N/A 
EMERGENCY CONTACT DETAILS
CONTACT PERSON: Olga B. Balbastro RELATIONSHIP: Mother
ADDRESS: 052. Brgy. H-Romero Zaragoza Nueva Ecija
CONTACT #: 09059364567
GOVERNMENT NUMBERS
 -1/ 2/ 1 / 1 / 8 / 7 / 2 / 5 / 8 / 6 / 4
NATIONALITY: Filipino  HDMF No. (12 digits): / 1 / /- 
-2/ 1 / 0/ 2 / 5 / 5 / 2/ 1 / 6/ 7/
TAX STATUS: S PhilHealth No. (12 digits): 2/ 9 / /- 
 -7/ 1/ 0 / 4 / 6 / 9 / 8/ 3/ 1 / -/ 0 / 2/ 4 / 1 / 1 / 1/ 5 /
TIN (9 digits): /-  SSS No. (10 digits): 4/ 6/ 6/-
EDUCATIONAL BACKGROUND
TYPE AND LOCATION NAME OF SCHOOL FROM TO
ELEMENTARY: Vincentian Catholic Academy
ADDRESS OF SCHOOL: San Vicente Zaragoza, Nueva Ecija
HIGH SCHOOL: Carmen National High School
ADDRESS OF SCHOOL:Carmen Zaragoza, Nueva Ecija
COLLEGE/
VOCATIONAL: Araullo University
ADDRESS OF SCHOOL:Brgy. Bitas, Cabanatuan City, Nueva Ecija
COURSE: BS - Civil Engineering YEAR GRADUATED: N/A
GRADUATE SCHOOL: 
ADDRESS OF SCHOOL:
COURSE: YEAR GRADUATED:
FAMILY RECORD
June 26,
FATHERS NAME:
Neil S. Balbastro Sr BIRTHDAY (mm/dd/yyyy): 1957
MOTHER FULL MAIDEN NAME: Olga DC. Bautista BIRTHDAY (mm/dd/yyyy): Nov. 2, 1970
SPOUSE INFORMATION
NAME OF SPOUSE: BIRTHDAY (mm/dd/yyyy):
BIRTHPLACE: MOBILE #
OCCUPATION: COMPANY NAME:
EMPLOYMENT HISTORY (start with your most recent employment)
COMPANY NAME: FBC ASIA PACIFIC  LAST POSITION HELD: TSR/NON VOICE
ADDRESS:  ORTIGAS PASIG CITY SUPERVISOR NAME: Sherry Mae Satumbaga
CONTACT #:   SUPERVISOR CONTACT #: 09262304396
EMPLOYMENT STATUS: Rendering START DATE: April 2021
REASON FOR LEAVING: Office location is too far.  END DATE: January 2022

COMPANY NAME: HT FINANCE  LAST POSITION HELD: Credit Investigator

ADDRESS:  ORTIGAS PASIG CITY SUPERVISOR NAME: Jomar Galang
CONTACT #:   SUPERVISOR CONTACT #:
EMPLOYMENT STATUS: Resigned START DATE: December 2019
REASON FOR LEAVING: The Company reduced their manpower due END DATE: April 2020
to pandemic. 

COMPANY NAME: LAST POSITION HELD: Team Leader/Credit

FISHRAY INCORPORATED  Verifier
ADDRESS:  MALATE MANILA SUPERVISOR NAME: Roxanne Santos

Version 3: 20181001
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CONTACT #:   SUPERVISOR CONTACT #:

EMPLOYMENT STATUS: Resigned START DATE: March 2019
REASON FOR LEAVING: Office relocate to malate manila, Mode of END DATE: December 2019
transportation from pasig to malate is very
hard. 

CHARACTER REFERENCES  
NAME: Yukareann Jeaneth Balbastro 
CONTACT NUMBER: 09277663142
RELATIONSHIP: Sister
NAME: Yoko Valerie B. Pascual
CONTACT NUMBER: 09989717204
RELATIONSHIP: Sister
NAME: Kimberly Alvarado
CONTACT NUMBER: 09127867134
RELATIONSHIP: Colleague
NAME: Guillano Amante
CONTACT NUMBER: 09262303586
RELATIONSHIP: Brother in law
NAME: Giam Paolo Pascual
CONTACT NUMBER: 09498847204 
RELATIONSHIP:  Brother in law
ADDRESS SKETCH

By signing this document, I confirm that I fully understand and take responsibility for the completion and submission of this New
Employee Form and hereby represent and warrant that all the information contained herein are true and correct and that if any
personal information/sensitive personal information of other persons is given by me, I have the right to do so and for the purpose
for which it has been given. I understand that a breach of such representation and warranty, including but not limited to any
misrepresentation, may be considered in evaluating whether I have met the standards for the regularization of my employment
and/or may subject me to disciplinary action (including termination) in accordance with applicable law or company policy of
Quantrics Enterprises Inc. (“Quantrics”), without prejudice to any other rights and remedies.

I consent to Quantrics’ collection, processing and disclosure of my personal information/sensitive personal information as disclosed
in this form or otherwise provided by me (or by any other person with my consent) to the Company, such as my age, residence,
medical records/history (collectively, “Personal Information”) for legal, personnel, administrative and/or management purposes,
including:
(1) Records required for background check and verification, Clearances, identification information, education, previous
employment, tax records
(2) Medical records
(3) Employment records including disciplinary action and notices
(4) fulfillment of Quantrics’ obligations as my employer.

I consent to any disclosure by Quantrics of my Personal Information to its partners, affiliates, and third party service providers or
agents (including its legal counsels), which may be located in or outside of the Philippines, for one or more of the purposes stated
above.

I further authorize Quantrics and its partners and affiliates to conduct a background check/verification relative to this form. I hereby
grant authority for the bearer of this letter to access or be provided with full details of my previous employment records.

I confirm that I am freely executing this form with full knowledge and understanding of my rights under the law, including my rights
as data subject under the Data Privacy Act of 2012.
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__________Neil Balbastro Jr / January 15, 2022________________________________

___________________________________________
Employee Name / Signature / Date Quantrics’ Representative / Signature / Date