APPLICATION FOR EMPLOYMENT

Instructions: This form is an official document. Please accomplish in full using BLOCK letters and indicate N/A if
field is not applicable. Check ( ) appropriate box.

Position Applied For/Position Key (if applicable): Have you taken BSP pre-employment test
before? Yes No
Department/Office, Branch: If yes, indicate the date?

Publication Date (if applicable): For what position and department?

How vacancy was known:

1. SURNAME FIRST NAME MIDDLE NAME For female married applicant, write Maiden
Name:

2. EMPLOYMENT HISTORY
Position Title
and Name and Address of Gov’t.
Inclusive Servic Reason for
Status of Company/Agency/Office e (Y/N)
Monthly Monthly
Dates Appointment Basic Allowances Leaving
(mm/dd/yyyy) (Specify if Salary
Permanent,
Temporary, Casual,
Contractual, etc.)

(Continue on separate sheet, if necessary)

SIGNATURE DATE

HR Form No. 02-001 * Version: 1 * Updated: 18 Aug 2017 Page 1 of 2

3. Are you related to any official or employee in the
BSP: a.) If yes:
a.) within the third degree of consanguinity (i.e. Name Relationship
mother, father, son, daughter, brother, sister,
nephew, niece, uncle, aunt, grandparent,
grandchild)? Yes No
b.) If yes:
b.) within the third degree of affinity Name Relationship
(i.e. mother-in-law, father-in-law, son-in-law,
daughter-in-law, brother-in-law, sister-in-law,
uncle-in-law, aunt-in law, grandparent-in-law,
grandchild-in-law)? Yes No
c.) If yes:
Name Relationship
c.) Other relative/s not mentioned in items a and b?

4. Have you ever been a respondent in any preliminary If “Yes”, state nature of the offense complained of
investigation before any quasi-judicial agency, Office of Status:
the Prosecutor or any law enforcement agency? On-going
Yes No Dismissed

5. What is the minimum 6. FOR APPLICANTS TO A SECURITY GUARD POSITION ONLY

salary you are willing to If considered, are you willing to be assigned/re-assigned to the Main/Security
accept? Plant Complex/regional offices/branches of the Bangko Sentral ng Pilipinas (BSP)
in the performance of your job? Yes No

Signature __________________________________

I declare that the answers given above are true and correct to the best of my knowledge and belief. I
understand that any false representation shall disqualify me from employment in the BSP, in which case, my
appointment, if one is issued, shall be revoked; such representation shall be grounds for an administrative case
for DISHONESTY and/or CONDUCT PREJUDICIAL TO THE BEST INTEREST OF THE SERVICE punishable under the
disciplinary rules on administrative cases both in Civil Service Commission and BSP.

I hereby waive my right to the confidentiality of the personal information disclosed in my personal data
sheet and application documents, and grant explicit authority to the BSP to conduct reference checks and other
forms of background investigation, as may be deemed necessary, for the purpose of evaluating my application
for employment in the BSP, and for securing the clearances pertinent thereto.

[Signature over Printed Name/ Date]

HR Form No. 02-001 * Version: 1 * Updated: 18 Aug 2017 Page 2 of 2