Important: All items must be properly filled-up.

“WRITE ALL INFORMATION IN CLEAR CAPITAL

LETTERS AND USE BLACK INK ONLY.”
(To be filled up by the worker)
Control Number: ______________________
Surname: _____________________ First Name : _____________________ Middle Name ____________
Address : ____________________________________________________________________________
Gender: _____ Civil Status: _____ Birth date: ___________________ Age: ______ Ex-Abroad: Y(__) N(__)
Email Address: ________________________________________ Religion: Muslim (___) Non-Muslim(___)
Mobile No.: ___________________________ (In-Case of Emergency) No.: _________________________
PEOS No.: ________________________________________ Date Created: _________________________
E-Registration No.: _________________________________ NBI Validity: __________________________
Passport No.: _____________________________ Place Issued: _________________ Date Issued: ______________ Expiring: ______________
Highest Educational Attainment: _________________________ Name of School: __________________________________________________
Last 2 Employers Course: _________________________________________________________
Company: ________________________________ Position: ______________________ Date Start: _____________ Date End: _____________
Company: ________________________________ Position: ______________________ Date Start: _____________ Date End: _____________
Dependents/Beneficiaries (Your beneficiaries in OWWA and Mandatory Insurance)
Name of Children/Parent/Spouse Gender Relationship Date of Birth
__________________________________________________ _______ ______________________ _______________________
__________________________________________________ _______ ______________________ _______________________
__________________________________________________ _______ ______________________ _______________________
__________________________________________________ _______ ______________________ _______________________
Orientation Date: ______________________ NH _____ TA _____ (To be filled up by PDG)
Consultant: ________________ DA: ________________ BU ____ Watch listed: Yes (___) No (___) Date: ______________________
Position: _____________________________________________ Remarks: ______________________________________________
Employer: ____________________________________________ ______________________________________________________
Country: ______________________Duration: _______________ Accreditation Approved on: _______________________________
Expiry Date: ________________ Contract Duration: ____________
(To be filled up by Consultant/DA) Approved Job order: _____________________________________
Final Selection Date: ____________________________________ Job Order Approval Date: _________________________________
Job Offer Acceptance Date: _______________________________ Expiry Date: ________________ Approved Salary: _____________
Contact Person: ________________________________________ Remarks: ______________________________________________
Position: ______________________________________________ ______________________________________________________
Salary Offered: _________________________________________ ______________________________________________________
Currency: _________________ Salary Term: _________________ ______________________________________________________
Date of Medical: _______________ Expiration: _______________ ______________________________________________________
FTW Date: ____________________Clinic: ___________________ ______________________________________________________
Remarks: _____________________________________________ ______________________________________________________
Re-Medical: ___________________ Expiration: _______________ ______________________________________________________
FTW Date: ____________________Clinic: ___________________ ______________________________________________________
Remarks: _____________________________________________ ______________________________________________________
Completion of Requirements Date ______________________________________________________
○ PEOS & E-Registration _________________
○ Passport _________________ NOTES
○ Pictures _________________ ______________________________________________________
○ NBI Clearance _________________ ______________________________________________________
○ Signed Letter Offer _________________ ______________________________________________________
○ Signed Employment Contract _________________ ______________________________________________________
○ Notarized CV _________________ ______________________________________________________
○ DFA Authenticated TOR/Diploma _________________ ______________________________________________________
○ Apostille Photocopy _________________ ______________________________________________________
○ PRC Authenticated Documents _________________ ______________________________________________________
○ Copy of IDs/Supporting Certificates _________________ ______________________________________________________
○ Medical Certificate _________________ ______________________________________________________
○ Polio & Yellow Fever Vaccine Cert _________________ ______________________________________________________
○ Final Exit (Ex Saudi) _________________ ______________________________________________________
○ Philhealth Receipt _________________ ______________________________________________________
○ Payment (Mettl Test & Pag-Ibig) _________________
(To be filled up by PDG)

AUTHENTIFICATION: In-Charge: ______________ VISA PROCESSING

(MIDDLE EAST BOUND) In-Charge: ______________
•DFA _________________ _________________ Sponsor Name: ______________________________________
Date Filed Date Released Sponsor # ___________________________________________
•Embassy _________________ _________________ Category: ___________________________________________
Date Filed Date Released Visa # _________________________ Received: ____________
Encoded: ______________ Med Validation: _______________
DOCKETING: In-Charge: ______________ Filing: ___________ Released: __________ Expiry: __________
Remarks: ___________________________________________
Envelopes/Documents Received: ________________________
___________________________________________________
Date & Time
___________________________________________________
Envelopes/Documents Received: ________________________
Date & Time
VISA PROCESSING
Remarks: ___________________________________________
(NON-MIDDLE EAST BOUND) In-Charge: ______________
___________________________________________________
_______________________________________________ Type of Visa:________________________________________
PRIOR TO OEC ISSUANCE: In-Charge: ______________ Application: _____________ Expected Release: ____________
Released Date: ______________ Validity: _________________
Insurance # _________________ Date: __________________ EC Received: ______________ Reviewed: _________________
PDOS Cert # _________________ Date: __________________ Remarks: ___________________________________________
Insurance # _________________ Date: __________________ ___________________________________________________
PDOS Cert # _________________ Date: __________________ ___________________________________________________
FINAL BRIEFING &
__1.Pictures (6 pcs) __16. PRC Authenticated RELEASE OF DOCUMENTS: In-Charge: ______________
__2.Tracking Forms Documents
__3.Insurance Form __17. Copy of IDs & Departure Date: _____________________________________
__4.POEA Approved EC Supporting Certificates PTA Received Date: __________________________________
__5.POEA Approved EC Attachments __18.OEC CIC/Client Advised Date: ______________________________
__6.POEA Approved Undertaking __19.PDOS Cert Flight Details: _______________________________________
__7.POEA Approved Workers Affidavit __20.E-ticket ___________________________________________________
__8.E-Registration ___________________________________________________
__9.Passport Copies (3 pcs) Payment Record for: ___________________________________________________
__10.Visa Photocopy Mettl Test ___________________________________________________
__11.PEOS Certificate Copy Philhealth ___________________________________________________
__12.Signed Employment Contract SSS OEC No: ____________________________________________
__13.Notarized CV Pag Ibig Processed Date: ______________ Expiry Date: _____________
__14.Copy/DFA Authenticated TOR/Diploma Final Briefing Date: ___________________________________
__15.Apostille Photocopy

(To be filled up by the worker on the release of documents)

ACKNOWLEDGEMENT / CONFIRMATION
This is to confirm that I intelligently certify that I have read and fully understood, and that an EDI Consultant/Officer had read
and fully explained to me each and every provision of my Employment Contract. I confirm that that no verbal promise or interpretation
has been made other than those stated in my contract. That I executed my contract under my own free will and not under Duress and
I did not pay any sum of money or other forms of consideration to any official, employee or legal representative of the employer and EDI
for employment covered herein. It is specifically agreed that the contract shall be subject to modification only if a written instrument
is signed by both Employer and Employee and that the same instrument has obtained written consent and approval of the POEA through
EDI-Staffbuilders International, Inc.

I acknowledge receipt of the following documents from EDI – Staffbuilders International, Inc. (EDI-SBII). I also confirm that I have
undergone the mandatory Pre-Departure Orientation Seminar (PDOS) and have been given final briefing on airport formalities.

DOCUMENTS RECEIVED UPON FINAL BRIEFING:

___1.Passport ___8. Philhealth MDR & OR

___2.OEC (4pcs /Original)
___3.PDOS Certificate
___4.E-Ticket
___5. Employment Offer/Contract
___6. Mandatory Insurance Certificate
___7. NBI
___9. Pag-Ibig Payment
___10. Pictures _____________________________________________
___11. OFW Kit (Handbook, fliers, etc.) SIGNATURE OVER PRINTED NAME
___12. Medical Certificate / X-ray plate
___13.Negative PCR Test result ___________________________________
___14.Other documents ______________ DATE / TIME
__________________________________