Shared Services Center

Human Resource Shared Services Department

PERSONNEL INFORMATION SHEET

Please accomplish this form truthfully and completely.

PERSONAL INFORMATION
Last Name First Name Middle Name

TIN SSS Number Pag-IBIG Number

Gender Civil Status Birthday Age Birthplace

Local City Address Provincial Address

Telephone / Mobile Number Religion Citizenship

Color of Eye Color of Hair Blood Type

Height Weight Distinguishing Mark

Languages Spoken

Name of Spouse (if applicable) Occupation

Local City Address of Spouse Provincial Address of Spouse

Name of Children Birthday Birthplace

Father’s Name Occupation Birthday

Mother’s Name Occupation Birthday

Parents’ Address Telephone / Mobile Number

Name of person to be contacted in case of emergency Telephone / Mobile Number

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Local City Address

Name of Brothers & Sisters (Siblings) of the Employee Gender Birthday

EDUCATIONAL BACKGROUND
Name of School Honors Received Date Graduated
Elementary

High School

If unable to finish High School, specify up to what year Do not fill-out this space if High School undergraduate
did you reach

Vocational School

If unable to finish Vocational School, specify up to Do not fill-out this space if Vocational School
what year did you reach undergraduate
Course

College

If unable to finish College, specify up to what year did Do not fill-out this space if College undergraduate
you reach
Degree/s Major

Graduate Studies/ Masteral Total Units Earned

Do not fill-out this space if Masteral undergraduate

Course

Other Studies Taken (e.g. computer, review, etc.)

Passing Score Rank/ Place if

Government/ Licensure Exams (Do not fill-out if Among Top Ten Date Taken
failed) Passers

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Skills

Office Machines/ Tools You Can Operate

EMPLOYMENT RECORD
Work Experience Prior to Employment in PJLI
Position Held Level (Staff/ Name of Company Inclusive Dates
Supervisory)

Various Positions Held within PJLI (from most recent)

Position Held Level (Staff/ Division/ Department/ Region/ Inclusive Dates
Supervisory) Area

Relatives Working in the Company up to the 4th Degree of Consanguinity/ Affinity

Name of Relative Specific Relation Division/ Department/ Region/ Area

TRAININGS/ SEMINARS ATTENDED

(Please attach copy of certificates.)

Please put a check mark on seminars you have attended.
In-house Training

Branch Operations Training Gold Appraising

Pera Padala Diamond Appraising
Administrative Assistant’s Development Program Team Building
Effective Business Writing Customer Service Wave 1
Facilitation Skills Internal Customer Service Wave 1
Interaction Skills for Success Customer Service Wave 2
Basic Supervisory Skills Internal Customer Service Wave 2

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Other Trainings/Seminars Inclusive Dates / No. Hours Internal/ External Trainers

I hereby certify that the abovementioned information is true and correct, that falsification/mis-representation of any of the
above information stated herein shall be a just cause for termination from P.J. Lhuillier, Inc. and its Affiliate companies, if
employed. I likewise give the Company the right to investigate the authenticity of the abovementioned information.

Conformé

Signature Over Printed Name Date

Left Thumb Mark Right Thumb Mark

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 Shared Services Center
Human Resource Shared Services Department

CONFIDENTIALITY AFFIDAVIT

I, __________________________________, Filipino, of legal, and with residence at ____________

(Employee’s Name)
___________________________________________ do hereby declare and
(Address)
state under oath as follows:

1. I am an employee of __________________________________________;
(Company)
2. For and in consideration of my employment with _____________and the compensation that I received
and/or will receive by reason of my said employment, I voluntarily and on my own accord, promise to and
hold myself responsible for the return and turn-over to __________ through its Chief Executive Officer, or
his duly authorized representative, any and all items, materials, documents or copies or reproductions
thereof that I may take or has taken into possession or, has been or would be issued to or, has been or will
be reproduced by me in the course of or in connection with my employment with __________ and
pertaining or relating to its business or to the business of any of its stockholders, directors, officers, and
other personnel, as well as all affiliates, subsidiaries and/or sister companies; for these purposes,
__________ “sister companies” and/or “subsidiaries” shall be any company, firm or corporation wholly
owned or majority owned by the family of Ambassador Philippe J. Lhuillier and Mrs. Edna D. Lhuillier and
any or all of their children together, in combination or singly.

3. Also, I hereby promise and hold and bind myself not to provide nor disclose to any third-party any of the
above-mentioned documents or any copies thereof either in whole or in part, as well as any content thereof
without the express written consent of ______________________;
(position and/or office of designated official)
4. Further, I hereby promise to hold and bind myself not to provide or disclose to any third party, without the
express and written consent of ______________________;, any information
(position and/or office of designated official)
relating to __________’s or any of its subsidiaries’ or sister companies’ proprietary technology and
products, including but not limited to technical data, trade secrets, know-how, research, product plans,
ideas or concepts, products, services, software, inventions, patent applications, techniques, processes,
developments, algorithms, formulas, technology, designs, schematics, drawings, engineering, and hardware
configuration information; including any information relating to the __________ or its subsidiaries’ or sister
companies’ operations and business or financial plans or strategies, including but not limited to customers,
customer lists, markets, financial statements and projections, product pricing and marketing, financial or
other strategic business, plans or information that may have come to my knowledge either directly or
indirectly, in writing, orally or by drawings or inspection of samples, equipment or facilities by reason of or
during my employment with __________;

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5. I hereby grant to, allow and permit __________, its management or, any of its officers to use this
document and any and all of my declarations, promises and covenants as contained herein as an
authorization and evidence to prevent and preclude the use by me or anybody acting for me, whether
with my consent or otherwise, of any item, material, document or copy or reproduction thereof, as
well as any information, as enumerated above, in testimony or in evidence before any tribunal,
agency, office or body without the prior express and written consent of __________, any of its
stockholders, directors, officers, and other personnel, as well as any of its affiliates, subsidiaries
and/or sister companies who shall be affected thereby;

6. I hereby understand, acknowledge, and unequivocally agree that in the event of any breach or violation
on my part of any of my above promises, declarations or covenant, I will be liable to __________, any
of its stockholders, directors, officers, and other personnel, as well as any of its affiliates, subsidiaries
and/or sister companies who has been affected by my aforementioned breach or violation in the
amount of not less than the equivalent of my five (5) year salary, based on the amount of my
latest salary from __________in any such case and instance, as and for liquidated damages,
without prejudice to such other damages that may be incurred by the company/ies and/or individuals;

7. Finally, all of my above undertakings and warranties shall continue to be applicable even after my
retirement, resignation or separation from the company.

IN WITNESS of the foregoing declarations and statements, I have affixed my signature on this affidavit this
____________________, in _____________________, Philippines.
(Date of Signing) (Place of Signing)

______________________________________ TIN: __________________

Signature over printed name

SUBSCRIBED AND SWORN TO before me this _______ day of _______________, 20__, in

_______________________, affiant exhibiting to me his Tax Identification No. ____________________.

Notary Public

Doc. No. _________

Page No. _________
Book No. _________
Series of 20 _________

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Human Resource Shared Services Department

ACKNOWLEDGMENT RECEIPT AND UNDERTAKING

I, _______________________________________, of ____________________, hereby

(Name) (Company)
acknowledge that I have received a copy of Empoyee Manual and Code of Conduct Issued by the Company.

Ako, si _____________________________________, ng ____________________,

(Name) (Company)

ay nagpapatunay na natanggap ko ang kopya ng Employee Manual at Code of Conduct na pinaiiral ng

Kumpanuya.

I hereby manifest that I have completely read and understood said Employee Manual and Code of
Conduct and hereby freely and voluntarily signify my full assent thereto and my pledge to comply faithfully with
all its provisions.

Ako rin ay nagpapatunay na nabasa ko nang buo at naintindihan ko ang nasabing Employee Manual at
Code of Conduct at ditto ako ay Malaya at kusang loob na nagsasaysay na aking buong pag-ayon at pagtanggap
ditto at ako ay nangangako sa susundin ko nang buong katapatan at walang pasubali at pag-aalinlangan ang
lahat ng nakasaad ditto.

_______________________, ____________________
(Place) (Date)

________________________________
Employee’s Name (PRINT)

________________________________
Employee’s Signature

________________________________
Position

Signed in the presence of:

_______________________________ _______________________________
Witness’ Signature over Printed Name Witness’ Signature over Printed Name

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Human Resource Shared Services Department

CONFIDENTIALITY CLAUSE

I, ___________________________________, do solemnly swear that in accepting my appointment in

the employ of PJ LHUILLIER Group of Companies, or any of its Affiliated Companies, I bind myself not to divulge,
reveal or pass on to any party or entity any and all information and/or knowledge pertaining to or concerning
PJ LHUILLIER Group of Companies or any of its Affiliated Companies, firms or corporations, or any of the
members of the family of Ambassador Phillippe J. Lhuillier, his wife, their descendants and/or ascendants, that I
may acquire or learn directly or indirectly by whatever means, by reason of my employment, my presence, or
the trust reposed on me as a consequence thereof, which may pertain but not limited to the following matters
which are considered of extreme confidentiality, to wit:

1. Financial Data
2. Operating Procedures
3. Trade Secrets
4. Intellectual Properties
5. Personal and/or Family Secrets

I, expressly understand that my separation from the service and employ of PJ LHUILLIER Group of Companies,
or any of its Affiliates will not it any way whatsoever terminate or severe this vow of confidentiality that I have
sworn to and that a violation of this confidentiality vow will be enough ground for my separation from the
service and constitures an actionable cause of action against me before the proper court of law.

Makati City, Metro Manila

________________________________
Signature over Printed Name

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Human Resource Shared Services Department

SWORN STATEMENT OF DECLARATION

In reference to my employment with P.J. LHUILLIER, GROUP OF COMPANIES, I hereby voluntarily declare and
sworn:

1. That I am not a 24K card holder;

th
2. That I have no and/or no more that one (1) relative up to the 4 civil degree of consanguinity and
affinity employed in the company;

3. That I, my spouse (if any) and immediate family members is never employed/or own a business similar
to my employer;

4. That I am not convicted of any crime of whatever nature;

5. That all information I provided in relation to my employment is true and correct to the best of my
knowledge.

I hereby agree and accept that any non-disclosure or misleading information in favor to my hiring with the
company may cause for the immediate termination of my employment contract.

IN WITNESS of the foregoing declaration and statement, I have affixed my signature on

____________________, in _____________________, Philippines.

________________________________
Signature over Printed Name
(Name of Employee)

_______________________________ _______________________________
Witness’ Signature over Printed Name Witness’ Signature over Printed Name

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Human Resource Shared Services Department

Name of Employee: _____________________________________________

RIGHT FINGERS

LEFT FINGERS

We hereby attest that the employee whose name appears above owns the fingerprints above:

WITNESSES:

_______________________________ _______________________________
Witness’ Signature over Printed Name Witness’ Signature over Printed Name

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Human Resource Shared Services Department

Name of Employee: _____________________________________________

RIGHT FINGERS

LEFT FINGERS

We hereby attest that the employee whose name appears above owns the fingerprints above:

WITNESSES:

_______________________________ _______________________________
Witness’ Signature over Printed Name Witness’ Signature over Printed Name

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Human Resource Shared Services Department

MEMO OF UNDERTAKING

I, _____________________________________________, __________________________
(Name of Employee) (Position)

of _____________________________shall submit my other necessary requirements to Human

(Company)
Resource Operations Department (HROD) on or before below stated date/s:

Requirements to be submitted Date to be submitted

________________________________ ________________________
________________________________ ________________________
________________________________ ________________________
________________________________ ________________________
________________________________ ________________________

I hereby understand that failure on my part to comply to the above-mentioned requirements and
submit the same on the given deadline will result to the discontinuance and/or immediate termination of my
employment contract with the Company.

_____________________________. _________________________
(Place) (Date)

________________________________
Employee’s Name (PRINT)

________________________________
Employee’s Signature
Signed in the presence of:

__________________________ _____ _______________________________

Witness’ Signature over Printed Name Witness’ Signature over Printed Name

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