Inoustriag Personen ‘ond Manacement Services, inc. eneratevawuationrorm JPAMS PERSONAL INFORMATION (APPLICANT PROFILE) 4-14 - 2022. carro PART | APPLICANT INFORMATION a Ss Nonetenmamite | Tye BA Fhakit TAKE CASATOL | 1 cs eed — _| Drarreman ___| Bote arith scr) a O8-02- (9594 ic kotvaara 2 gmail L 63 - gor -03t $514 PO 994- See 0144 mmisémis gisew Tn. MAnKIED 4% by PoP How did you learn about Ipams?_ OMUNE laze refer to Boge Pat I of his oppiction farm. ‘waaine Foea wad ienased” "7" ES] matenn denen’ "Ena tmployee Relations Department staus; [7] Noderagatory record» ([] Not Recommended yaTION AND EVALUATED BY: Status: Shortlisted. Failed Talent Pool, (Full Name/Signature of recruiter) ariment Form 002 General Evaluation Form (Front), 1 Revised Fesruary 40,2022 ‘Al ights reserved, no part of his publeston may be reproduced, stored a2 reovl system. vensnited inary fom of by ary moans lactone ‘mochanieal photocopying, rca raoraas, thot te prior writen pemtesion of PANS Racrdtmet TearPART ll MEDICAL STATUS DECLARATION Please complete this form and deciare fully 2ll medical conditions. Falure to do so can mean cancellation of your application. Pesci True Creo Tenna 7 0 Family Name ea eee 20/23 (sere Name of Medical Facility / Place HOUITRL (PARED oR Please put 2 Check (V} under the YES or NO column if iagnosed having the following conditions, and ‘Trestment / Corrective Procedure ‘Thyroid Problem Hernia © Currently taking medicine no[F] (if yes, please indicate for wh 1nd generic name of medicine) + Vicot? Smoke/Vape[—] Drinking Alcohol [~] COVI-19 VACCINE STATUS (Check all if completely vaccinated and state details) ast shot [] 2nd shot [7] Booster No Plans of Getting Vaccinated Date: OCT: If, 7021 Date:_MOV- 04, 701 date: Brand:_PP1z ery Brand:__ PP tw Brand: Country:_PHIVPPIME $ — Country:__PHIGIPPIRT country: CERTIFIED CORRECT: ecrutment Department Form 002 General Evahiation Form (Back) 2 Revieod Febrosty 1, 2022 ‘Al rights reserved, ro part of his publcaton ey be reproduced, stored h @reievel system, tensrited nan form of by any means, electronic, ‘machanial,phatncenyin, rearing orcthense, ho the or wien parmsson af PALS Rectan! Team