HONDA PHILIPPINES, INC.

LOT 34, PHASE 1 B, FIRST PHILIPPINE INDUSTRIAL PARK, TANAUAN CITY, BATANGAS PICTURE
2X2

APPLICATION FOR EMPLOYMENT

POSITION APPLIED FOR: Sr. Associate Project Coordinator Date : 11/28/2022

PERSONAL INFORMATION
NAME: Last First Middle Nickname

GOMEZ ROMMEL VELASQUEZ Rho

METRO MANILA ADDRESS: Tel./Cellphone No.
9185607783
PROVINCIAL ADDRESS: E-mail Address
084 Regidor Street. Poblacion 4 Moncada Tarlac rommelgomez11@gmail.com
BIRTHDAY BIRTHPLACE SEX CIVIL STATUS
mm/dd/yy DAGUPAN CITY (x) Male (x) Single
10/11/1993 ( ) Female ( ) Married
HEIGHT WEIGHT BLOOD TYPE CITIZENSHIP RELIGION ( ) Widowed
5 ft. 4 in. 150 lbs (+A) FILIPINO CATHOLIC ( ) Other
TIN: 771-140-591-0000 Pag-Ibig No:/ HDMF No:

SSS NO: Driver's License No: C11-22-001262 ( )Prof. ( ) non-Prof. Code 1, 2, 3

PhilHealth No. : 07-051143750-2

EDUCATIONAL & PROFESSIONAL RECORD

YEARS ATTENDED
LEVEL (yyyy-yyyy) SCHOOL /COMPLETE ADDRESS COURSE / MAJOR AWARDS RECEIVED

Elementary University of Luzon

Secondary Moncada Catholic School
Vocational 2010-2012 Central Institute of Technology ComProg NCIV
College 2014-2019 Panpacific University Civil Engineering
Graduate Studies

PROFESSIONAL EXAM/S TAKEN DATE RATING

MEMBERSHIP IN PROFESSIONAL/ INCLUSIVE

POSITION/S HELD
CIVIC/ RELIGIOUS ORGANIZATIONS DATES
Philippine Institute of Civil Engineer 2014-2019 Student Member

FAMILY INFORMATION
FAMILY NAME BIRTHDAY CIVIL OCCUPATION/
MEMBERS LAST FIRST MIDDLE (mm/dd/yy) STATUS EMPLOYER
FATHER Zarraga Pio Romel Rosario Factor Worker
MOTHER Gomez Ma Corazon Velasquez Business Woman
BROTHERS Gomez Geoffrey Velasquez Single n/a
Gomez Tonichi Jan Velasquez Single BPO
Gomez Jake Nicolas Velasquez Single BPO

SISTERS

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HPI-REC-F-03-02
IF MARRIED:
NAME OF SPOUSE: LAST FIRST

OCCUPATION:
EMPLOYER: OFFICE PHONE:
OFFICE ADDRESS:
BIRTHDATE (mm/dd/yr.) MARRIED ON AT
/ / (Date) (Place)
CHILDREN:
FIRST NAME SEX B-DATE FIRST NAME SEX B-DATE

MEDICAL HISTORY

1. Do you have any present or past medical history which may disqualify you from some job
assignments? ____________ If so, indicate the condition__________________________________
2. Have you had any injuries, hospitalization or accidents in the past two years? ____________ If yes, please
explain________________________________________________________________________________
3. Check any of these conditions you have or have had:

Allergic disorders (asthma, rhinitis, skin disorders)
Cardiovascular conditions (elevated blood pressure, anemia, heart problems)
Gastrointestinal problems (ulcers, liver disease, bowel problems)
Musculoskeletal (fractured bone, disc or joint problems)
Tattoo or any artificial marks
Vision problems (glasses, defects or disease)
Auditory problems ( hearing impairment, vertigo)
Congenital ailments
Pregnancy
(Please explain _______________________)

Others (Please explain: _________________________________________________________________)

TRAINING PROGRAMS/SEMINARS ATTENDED

DATE TRAINING INSTITUTION/
SEMINAR/PROGRAM TITLE
ATTENDED CENTER
6/6/2018 On-the-Job Training (240 Hours) Philippine National Railways
9/20/2018 National Civil Engineering Symposium University of the Philippines
9/7/2018 1st Region 1 Civil Engineering Summit Northwestern University
Jun Symposium of Architech Felino "Jun" Palafox Jr, University of the Cordilleras

SPECIAL QUALIFICATIONS/INTERESTS
MACHINES / EQUIPMENT YOU CAN OPERATE

HOBBIES/ TALENTS/ SPORTS

OTHER QUALIFICATIONS OR SPECIAL ABILITIES

LANGUAGES / DIALECTS SPOKEN:

English, Tagalog

HAVE YOU EVER BEEN ACCUSED OR CONVICTED OF ANY CRIME IN THE PHILIPPINES?
If yes, state details. NO

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HPI-REC-F-03-02
WORK EXPERIENCE
(START WITH PRESENT EMPLOYER)

Name of Company & Industry: Philippine Statistics Authority Position Registration Officer 1
Address / Telephone No. /TIN
Immediate Superior/ Position: Arlene Orcino Basic Salary: 14,000
Inclusive Dates: 02/2021 - 08/2021 Reason for leaving: End of Contract
Brief Description of Duties and Responsibilities:
Captures Demographic and biometric data of aplicants, provides exceptional customer service, maintains and
exports daily captures data.

Name of Company & Industry: Philippine Statistics Authority Position:

Address / Telephone No. /TIN
Immediate Superior/ Position: Liza T. Cruz Basic Salary: 6500
Inclusive Dates: 09/01/2020 - 09/30/2020 Reason for leaving: End of Contract
Brief Description of Duties and Responsibilities:

Name of Company & Industry: Position

Address / Telephone No. /TIN
Immediate Superior/ Position: Basic Salary:
Inclusive Dates: Reason for leaving:
Brief Description of Duties and Responsibilities:

Name of Company & Industry: Position

Address / Telephone No. /TIN
Immediate Superior/ Position: Basic Salary:
Inclusive Dates: Reason for leaving:
Brief Description of Duties and Responsibilities:

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HPI-REC-F-03-02
CHARACTER REFERENCES:
NAME RELATIONSHIP ADDRESS / PHONE NO.
Irene Dimmangna Causin 9487616440
Brian Louie Tolosa Friend

DO YOU HAVE ANY FAMILY MEMBERS OR RELATIVES WHO ARE PRESENTLY EMPLOYED IN THIS
COMPANY OR OTHER MOTORCYCLE INDUSTRIES?
NAME RELATIONSHIP POSITION COMPANY
1
2
3
4
5

How did you learn about the job opening? MyJobStreet.com

PERSON TO CONTACT IN CASE OF EMERGENCY: RELATION : Mother

ADDRESS: Pobmacion 4 Moncada, Tarlac TEL. NO. 09063836835

DATE AVAILABLE FOR EMPLOYMENT EXPECTED SALARY

18,000

By signing this form below, I manifest that I read the Data Privacy Notice of Honda Philippines, Inc. and agree to
thereto and give my consent to the collection and processing of my personal data in accordance thereto and
Republic Act No. 10173 (“The Data Privacy Act of 2012”).

I hereby certify that the statements I have made in this Application for Employment Form are true and correct that
any misinterpretation, falsification or willful omission herein shall be sufficient cause for refusal of employment or
summary separation from the company's service, if employed.

I hereby authorize Honda Philippines, Inc. to investigate the accuracy and completeness of the information
contained herein.

I agree to submit myself to physical examination as pre-requisite for employment. I further agree and understand
that non disclosure of any ailments and/or disabilities (congenital and otherwise) shall also be valid ground for refusal
of employment or separation from company's service, if employed.

ROMMEL VELASQUEZ GOMEZ

SIGNATURE OF APPLICANT OVER PRINTED NAME

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HPI-REC-F-03-02