PHOTO

APPLICATION FOR NON-TEACHING

Date: __________________________
Head, Technical Support Unit
Position applies for: ___________________________________________________________

Name: Agellon
____________________________ Raniel Eran
_____________________________ Alvarez
____________________
Surname Given Name Middle Name
Present Address:
Fauni Compound Salitran II, Dasmarinas City

Permanent Address:
Fauni Compound Salitran II, Dasmarinas City

Contact Details: Landline No: Mobile No:

09068466888
Email :
raagellon@gmail.com
Sex at birth: ✔ Male Female
SSS No: 3414463049 PhilHealth No: 080255147947
TIN No: 275632969 Pag-ibig No: 121118698542

EDUCATIONAL BACKGROUND:
YEAR ATTENDED GRADE / DEGREE
DEGREE SCHOOL ATTENDED FROM TO ATTAINED
Grade Pintong Gubat Elementary School Primary
1996 2002
School
High Paliparan National High School Secondary
2002 2006
School
Senior De La Salle University Dasmarinas Two-year certificate
2006 2008
High School
College De La Salle University Dasmarinas 2009 2013 Bachelor Degree

Post
Graduate

Licensure Exam PRC: Yes ✔ No PRC No: ________________________________________

Others: _________________________________________

Do you have any relative/s employed with DLSMHSI? Yes ✔ No

If Yes, please specify WHO and HOW are you related to them _______________________________________________

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PREVIOUS EMPLOYMENT:
Employer Name / Address:
DE LA SALLE HEALTH SCIENCES INSTITUTE
Position: Salary: Tenure of Employment:
PC Network Support June 2017 - Present
Reason for Leaving:

Employer Name / Address:

DE LA SALLE HEALTH SCIENCES INSTITUTE
Position: Salary: Tenure of Employment:
Assistant Multimedia Technician June 2014 to June 2017
Reason for Leaving:

Employer Name / Address:

EURO-MED LABORATORIES PHIL., INC.
Position: Salary: Tenure of Employment
Production Technician
3 months
Reason for Leaving: Taking Bachelor's degree

LEGAL CASE FILED OR RESPONDED

Did you file a case against anyone? ? Yes ✔ No
Did you ever become a respondent to any case? ? Yes ✔ No
Have you’ve been convicted of any crime? ? Yes ✔ No

REFERENCES: Give at least 3 references other than former employer. Do not list relatives.
NAME BUSINESS EMAIL ADDRESS CONTACT NUMBER
Carlou B. Adao IT Officer I carlou.adao@deped.gov.ph 046 432 9355 loc 220
Searcy Blaine V. Granito Technical Analyst searcy.granito@globe.com.ph 09651881625
Jemaruh A. Cajuday Revenue Officer III jemcajuday@gmail.com 09171350501

CONFIRMATION

Raniel Eran A. Agellon

I, ______________________________________, hereby authorize De La Salle Health Sciences Institute and/or their
appointed Agent/Company to verify, countercheck and gather any and all information that I have provided in this
Application for Employment necessary, related or reasonably material to my employment application including but not
limited to my identity, address, origin, marital status, race, and affiliations, health, education, personal data, government
licenses, dealings with any government agencies, bank or other financial institution, or information about any judicial,
quasi-judicial or administrative case or proceeding, filed for or against me and for this purpose, De la Salle Health Sciences
Institute and or/their appointed Agent/Company may conduct inquiries as may be necessary at the company’s discretion. I
hereby release all persons from liability on account of such disclosure.
In relation to the Data Privacy Act of 2012. I further confirm that I have expressly consented to and authorized
the collection, holding, processing and use of my personal information, of whatever nature and however extensive, in
relation to my application for employment, actual employment, and post-employment recording/verification.
In witness whereof, I have affixed my signature below.

__________________________________________ __________________________
SIGNATURE OVER PRINTED NAME DATE SIGNED

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