DATA CAPTURED FORM

Please attach
BASIC INFORMATION 2X2 PICS

FULL NAME:
LAST NAME FIRST NAME MIDDLE NAME
AFP SERIAL NUMBER: BOS:
LAST NAME: FIRST NAME:
MIDDLE NAME: EXTENSION NAME:
NICK NAME: RANK:
CATEGORY: STATUS:
OFFICE ASSIGNMENT:
DESIGNATION: CLASSIFICATION:
GENDER:
*AUTHORITY:
SO/GO NR UNIT DATE
CIVIL STATUS: CITIZENSHIP:
BIRTHDATE: IDENTIFICATION MARK:
BIRTHPLACE: ETHNIC GROUP:
RELIGION: BLOOD TYPE:
BODY BUILT: HEIGHT: (ft./m) WEIGHT: (kg)
EYE COLOR: HAIR COLOR:
 IF MARRIED
SPOUSE INFORMATION
NAME:
CONTACT NUMBER: DATE OF BIRTH:
DATE OF MARRIAGE: OCCUPATION:
EMAIL ADDRESS: PLACE OF BIRTH:
PLACE OF MARRIAGE:
ADDRESS:
FAMILY BACKGROUND:
DEPENDENTS:
NAME B-DAY RELATIONSHIP ADDRESS

PRESENT ADRESS:

HOUSE NUMBER: STREET:

SUBDIVISION: BRGY:
TOWN/CITY: PROVINCE:
ZIP CODE:

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PREVIOUS ADDRESS:

HOUSE NUMBER: STREET:

SUBDIVISION: BRGY:
TOWN/CITY: PROVINCE:
ZIP CODE:

CONTACTS:

LANDLINE #: MOBILE # 1:
MOBILE #2: EMAIL ADD:
CONTACT PERSON:

CONTACT NAME:
ADDRESS:
RELATION: MOBILE #:
EMAIL ADD:

ID CARD:

TIN #: GSIS #:
PAG- IBIG #: PHILHEALTH #:
SSS #:

TARRIF SIZES:
COMBAT BOOTS: BDU: CAP:
T-SHIRT: SHORT: DRESS SHOES:

SOURCE OF ENLISMENT:
AUTHORITY
SO/GO NR UNIT DATE

STATEMENT OF SERVICE:

ASSIGNMENT/ REASSIGNMENT:
RESERVIST COMPONENT:
UNIT ASSIGNMENT:
MOBILIZATION CENTER:
TYPE: POSITION:
DATE FROM: DATE TO:
AUTHORITY:
SO/GO NR UNIT DATE
PROMOTION:
RANK: RANK STATUS:
DATE FROM: DATE TO:
AUTHORITY:
SO/GO NR UNIT DATE
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ACTIVE SERVICE:
TYPE: PURPOSE:
AUTHORITY:
SO/GO NR UNIT DATE

EDUCATIONAL BACKGROUND:

CIVILIAN SCHOOLING:
EDUC LEVEL COURSE SCHOOL NAME DATE GRADUATED
PRIMARY

SECONDARY

TERTIARY

BOARD ELIGIBILITY:

TYPE OF LICENSE:
DATE OF EXAMINATION:
LICENSE NUMBER:
BOARD RATING:

MILITARY SCHOOLING:

TRAINING:

COURSE NAME SCHOOL CONDUCTED BY DATE FROM-TO

SCHOOLING:
COURSE NAME SCHOOL CONDUCTED BY DATE FROM-TO

SEMINAR:
COURSE NAME SCHOOL CONDUCTED BY DATE FROM-TO

WORK HISTORY:
OCCUPATION:

POSITION:
COMPANY NAME:
DATE FROM: DATE TO:

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AWARDS AND DECORATIONS:

MILITARY AWARD:

AWARD TYPE AWARD ACHIEVEMENT AUTHORITY

DESCRIPTION

APPRECIATION/ RECOGNITION, PLAQUE OF MERIT, SPECIAL AWARDS:

AWARD TYPE AWARD ACHIEVEMENT AUTHORITY

DESCRIPTION

COMMENDATION:

GIVEN BY DATE AWARD

SIGNATURE OVER PRINTED NAME