Академический Документы
Профессиональный Документы
Культура Документы
INSTRUCTIONS
1. Answer all questions completely; if questions are not applicable write "NA", write "UNKNOWN" only if you do not know he answer and cannot obtain the answer from personal records. Use the blank pages at the back of this form for extra details on any question from which you do not have sufficient space. 2. Type, print or write carefully, illegible or incomplete form will not receive consideration.
WARNING
1. The corrections to all statements or entries made herein will be investigated. 2. Type, print or write carefully, illegible or material facts may give sufficient cause for denial of clearance. 3. That statements made herein are classified CONFIDENTIAL. Revelation or use of other than the authorized purpose is prohibited.
I.
PERSONAL DETAILS:
FIRST NAME: MAIDEN NAME: POB: RELIGION: MIDDLE NAME: CIVIL STATUS:
LAST NAME: NICKNAME: DATE OF BIRTH: HOME ADDRESS: (Hse Nr/St/Brgy/Bo) TOWN/MUN/CITY OR PROV: HOME TEL NR: POSITION / DESIGNATION: UNIT / OFFICE: DATE OF MARRIAGE: TIN: EMPLOYEES ID NR:
NATIONALITY: CITIZENSHIP:
II.
SEX: HAIR:
PERSONAL CHARACTERISTIC:
AGE: WEIGHT:(2.2/KGS) BLOOD TYPE: BUILD: COMPLEXION: EYES: HEIGHT: (2.54/CMS)
III.
MARITAL HISTORY:
MIDDLE NAME: POB: OFFICE ADDRESS: NATIONALITY: NICKNAME: TEL NR. DATE NATURALIZED:
SPOUSE NAME: DATE OF BIRTH: HOME ADDRESS: OCCUPATION: OFFICE TEL NR: PLACE OF NATURALIZED:
IV.
FATHER DATE OF BIRTH: HOME ADDRESS: PLACE OF EMPLOYMENT: MOTHER DATE OF BIRTH: HOME ADDRESS: PLACE OF EMPLOYMENT: GUARDIAN DATE OF BIRTH: HOME ADDRESS: PLACE OF EMPLOYMENT: FATHER IN LAW DATE OF BIRTH: HOME ADDRESS: PLACE OF EMPLOYMENT: MOTHER IN LAW DATE OF BIRTH: HOME ADDRESS: PLACE OF EMPLOYMENT:
NATIONALITY: POB:
NATIONALITY: POB:
NATIONALITY: POB:
NATIONALITY: POB:
V.
EDUCATIONAL BACKGROUND
NAME OF SCHOOL LOCATION INCLUSIVE DATE DEGREE EARNED
A.
ELEMENTARY
B.
HIGH SCHOOL
C.
COLLEGE
E.
F.
ELIGIBILITY CIVIL SERVICE ELIGIBILITY / BOARD / BAR DATE OF EXAM RATING PLACE OF EXAM
VI.
EMPLOYMENT HISTORY:
AUTHORITY OF ENTRY TO SERVICE:
PRESENT DESIGNATION:
POSITION OFFICE DATE REMARKS Primary Secondary Tertiary
SPECIAL SKILLS
OTHER QUALIFICATIONS:
LANGUAGE /DIALECTS:
LANGUAGES /DIALECTS SPEAK READ WRITE
VII.
VIII. PLACE OF RESIDENCE SINCE BIRTH: ( USE BACK SPACE FOR MORE DATA )
PLACE OF RESIDENCE INCLUSIVE DATES
X.
EVER BEEN ARRESTED? NO YES ANY RELATIVE ARRESTED? NONE YES ANY ADMINISTRATIVE CASE? NO YES VIOLATION OF PD 1802? NO YES NARCOTIC OR LIQUOR USE? NO YES ARE YOU WILLING TO UNDERGO PERIODIC LIE DETECTION TEST? NO
YES
XI.
CHARACTER REFERENCES
LENGTH OF ACQUAINTANCE
NAME
BUSINESS ADDRESS
OCCUPATION
XII.
CREDIT REPUTATION:
NO NO
ARE YOU DEPENDENT ON YOUR SALARY? YES OTHER SOURCES OF INCOME? YES NO HAVE YOU FILE YOUR ASSET AND LIABILITIES? YES WHAT AGENCY? YES NO HAVE YOU FILE YOUR ITR? YES NO AMOUNT PAID
CREDIT REFERENCES:
NAME BUSINESS ADDRESS
I certify that the foregoing answers are true to the best of my knowledge and belief and I agree that misstatement or commission as to material fact will be for immediate denial of my application. Signed at Date:
(Witness)
(Witness)
Photo (2 x 2)
Subscribed and sworn to before me this ________ day of ________________________20 ___ at Bureau of Immigration, Intramuros, Manila, Philippines, and affiant exhibiting to me his / her Residence Certificate Nr _______________ issued at __________________________ on ____________________________.
Administering Officer