HRDv********

AGE STATUS BIRTHDATE

SEX HEIGHT WEIGHT

OTHER DEPENDENTS

OCCUPATION/EMPLOYER

OCCUPATION/EMPLOYER

AGE OCCUPATION

LEVEL SCHOOL NAME GRADUATED YEAR ATTENDED

ELEMENTARY YES NO TO

HIGH SCHOOL YES NO TO

COLLEGE YES NO TO

OTHER STUDIES YES NO TO

VOCATIONAL YES NO TO

WORK EXPERIENCE

NAME OF COMPANY/ADDRESS PHONES NOS. DATES NATURE OF WORK SALARY REASONS FOR LEAVING ATTACH PHOTOS HERE

CONTINUED AT THE BACK

LANGUAGES/DIALECTS SPOKEN DEGREE/ ATTAINMENT

APPLICATION REFERENCE (HOW DID YOU FIND OUT ABOUT OUR COMPANY?) SCHOOL RECORD

ADDRESS/PROVINCE

NAME EMPLOYER

IF MARRIED, SPOUSE'S NAME OCCUPATION/EMPLOYER

NUMBER OF CHILDREN

FATHER'S NAME

MOTHER'S NAME

NAME, OCCUPATION AND RESPECTIVE EMPLOYER OF EACH BROTHER AND SISTER BIRTHPLACE

RELIGION

SOCIAL SECURITY NUMBER TAX IDENTIFICATION NUMBER

PERSONAL BACKGROUND

PRINT NAME IN FULL

FIRST NAME MIDDLE NAME

PRESENT ADDRESS TELEPHONE NUMBER

MOBILE NUMBER

E-MAIL ADDRESS

APPLICATION FOR EMPLOYMENT

DATE APPLIED : SOURCE/THRU:

2PCS.

1" X 1" PHOTO

WHITE BACKGROUND

JOB FAIR MAILERS/ LETTERS WALK-IN ADVERTISEMENTS/ NEWPAPERS FRIENDS/ RELATIVES WEBSITES/ INTERNET AGENCY

LAST NAME

FIRST NAME MIDDLE NAME LAST NAME

FIRST NAME MIDDLE NAME LAST NAME

FIRST NAME MIDDLE NAME LAST NAME

OWNED RENTED

BORDER RELATIVE

PLEASE ANSWER FRONT AND BACK PAGES, CLEARLY PRINT IN BLOCK LETTERS AND DO NOT LEAVE BLANKS. POSITION APPLIED FOR:

INCLUSIVE DATES

DO YOU HAVE ANY SKILLS IN THE USE OF THE FOLLOWING? PLEASE CHECK PC TROUBLE SHOOTING INTERNET EXPLORER MS WORD

VEHICLE MAINTENANCE WINDOWS 98X MS EXCEL

COMPUTER MAINTENANCE WINDOWS 2000 MS POWER POINT

COMPUTER NETWORKING WINDOWS XP MS ACCESS

LANDSCAPING WINDOWS NT SERVER MS PUBLISHER

ART

ALLERGY VISON HEARING

ASTHMA IMPAIRMENT DEFFECT

HAY FEVER CORRECTIVE GLASSES HEARING AID

HIVES CORRECTIVE CONTACT LENS LOSS

SKIN CARDIOVASCULAR CONDITIONS GASTROINTESTINAL DISORDER ASTHMA HIGHBLOOD PRESSURE ULCER

BOILS ANEMIA LIVER DISEASE

EXCESSIVE ACNE HEART ABNORMALITIES BOWEL PROBLEMS

PSORIASIS

CHARACTER REFERENCES (NOT RELATED TO YOU)

NAME ADDRESS TELEPHONE NOS.

GENERAL INFORMATION

OCCUPATION

HAVE YOU BEEN SUPPORTING ANY LABOR ORGANIZATION? IF YES, WHICH AND SINCE WHEN? HAVE YOU EVER BEEN CONVICTED OF ANY CRIME OR ACCUSED OF CRIMES INVOLVING MORAL ACTIONS? IF SO, PLEASE DESCRIBE.

DO YOU HAVE ANY RELATIVES/S EMPLOYED WITH OUR COMPANY OR WITH OUR CLIENTS WITHIN THE DEGREE OF CONSANGUINITY? IF YES, PLEASE ELABORATE

DISLOCATIONS

JOINT PROBLEMS

ARTHRITIS

PLEASE SPECIFY OTHER HEALTH CONDITIONS THAT MAY NEED SPCIAL CONSIDERATION AS TO JOB ASSIGNMENTS EXTRA CURRICULAR ACTIVITIES /AWARDS

TRAINING / SEMINARS

SUPPLEMENTARY INFORMATION

MEDICAL HISTORY

INSTITUTE/TRAINING ORGANIZATION

ADOBE PAGEMAKER

ADOBE PHOTOSHOP

VISUAL BASIC

WEB DESIGN

COREL DRAW

COREL PHOTOSHOP

FRACTURED BONES

TITLE OF SEMINAR / COURSE

TUBERCULOSIS

PNEUMONIA

BRONCHITIS

MUSCOSKELETAL PROBLEMS

HAVE YOU HAD ANY ILLNESS, ACCIDENTS OR HOSPITALIZATION IN THE PAST (5) YEARS? IF YES, PLEASE EXPLAIN. CHECK ANY OF THE FOLLOWING CONDITIONS YOU HAVE OR HAVE HAD RESPIRATORY CONDITIONS

I understand and agree that a background investigation can and may be conducted relative to my application. I assure that all information iI have supplied in this application are true, accurate and complete, and agree that any falsification, or any omission which tends or may tend to mislead, will be considered sufficient cause for immediate termination of my employment and my outright dismissal from the company, upon discovery thereof or at any time thereafter. I unconditionally waive the right which I may have to conest such dismissal resulting from my withholding or falsifying information in this application. APPLICANT'S SIGNATURE DATE SIGNED

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