HR_Department_Form_Revision_1_2022

APPLICATION FORM
PERSONAL INFORMATION
Last name First Name Middle Name Suffix
Position Applying For: Availability for Employment: Desired Salary:

Contact Number: Email Address:

Place of Birth: Birth Date: Age:

Gender: Civil Status: Religion Citizenship:

Current Home Address:

Permanent Home Address:

SSS Number: TIN Number: Philhealth Number: Pag-Ibig Number:

Emergency Contact Details:
Complete Name: ________________________________________ Relationship to the Applicant:_______________________
Mobile Number:_________________________ Home Adrdress: ____________________________________________________
Do you have any relative/s working under the government? If yes, kindly indicate the details below
Complete Name: ________________________________________ Relationship to the Applicant:_______________________
Mobile Number:_________________________ Home Adrdress: ____________________________________________________
EDUCATIONAL BACKGROUND
Name of the School Year Graduated
Primary:
Secondary:
Tertiary:
Bachelor’s Degree/ Course:
Vocational/Special Skills:
EMPLOYMENT HISTORY
Company Name Position From-To(Date) Reason for Leaving
1

4
 CHARACTER REFERENCE
Complete Name Company Name Job Position Contact Number
1

HEALTH AND WELLNESS PROFILE

MEDICAL BACKGROUND:
Do you have any disability? _____ Yes _____ No
If yes, please categorize your impairment:
____ Visual ____ Hearing ____ Mobility ____ Learning Disability ____ Mental Health Condition ____ Others
When were you last admitted to hospital? ________________________________________________________________
What was the reason for hospitalization?__________________________________________________________________
Check for the following VICES if applicable:
 Liquor ____ Never ____ Once ____ Sometimes ____ Often
 Cigarette ____ Never ____ Once ____ Sometimes ____ Often
 Prohibited Drugs ____ Never ____ Once ____ Sometimes ____ Often
 Gambling ____ Never ____ Once ____ Sometimes ____ Often

I hereby certify that the information given above are true and correct to the best of my knowledge.
Moreover, I hereby authorize the Company, to collect and process the data indicated herein for the purpose of
maintaining an accurate record bank of employees' data to facilitate pertinent transactions in connection with
employment. I agree to answer this application form with all honesty and credibility as I am fully aware that any false
and/or inconsistent information that may be gathered about me through this and as a result of background check is
tantamount to perjury that is unacceptable to the Company and shall be a strong ground for dismissal of my
employment and imprisonment of up to two (2) years.

____________________________________________________ ______________________________
Signature over printed name Date