Control Number: _______________

DEPARTMENT OF ENERGY
Energy Center, Rizal Drive, Bonifacio Global City
1632 Taguig City, Philippines

APPLICATION FOR EMPLOYMENT

Source :

Website

Walk-in

Jobfair

Referral :

Position Applied For :

1st
Choice

2nd
Choice

(Surname)

Please attach recent

ID picture
3.5 cm x 4.5 cm
(passport size)

Salary Desired :

(First Name)

(Middle Name)

Nickname

Present Address
(No.)

(Street)

(Village/Town)

(City)

(Postal Code)

(No.)

(Street)

(Village/Town)

(City)

(Postal Code)

Provincial Address
Contact Numbers
(Telephone Number)

Age

(Cellphone Number)

Birthdate

(E-Mail Address)

Birthplace

Sex

Pag-ibig No.

TIN

Height

Weight

(mm/dd/yyyy)

SSS No.
GSIS No.

Philhealth No.

Civil Status

Single

Pls Check One

Married

Religion

Annulled

Staying at own house

Separated

Renting

Widowed
Staying with Relatives

Languages / Dialects Spoken

Interests / Hobbies / Past time
Other Special Skills / Can operate or use (machines/eqpt/software)
Other special qualifications, books published, article written
Are you willing to be assigned in the province?

Yes

No

If yes, indicate what preferred location

EDUCATION
Name & Address of School Attended

Course / Degree / Major

Inclusive Date of Attendance

Elementary
Secondary
Vocational
College
Post Graduate
Study / Scholarship Grant

EMPLOYMENT HISTORY
(Start with your present or latest job)

A. Company
Address / Tel. #
Employment Date: From
Position at Start
Status of Appointment
Job Description

Nature of Business
Immediate Superior
To
Position at Leaving
Leaving Salary

Reason for Leaving

B. Company
Address / Tel. #
Employment Date: From
Position at Start
Status of Appointment
Job Description

Nature of Business
Immediate Superior
To
Position at Leaving
Leaving Salary

Reason for Leaving

C. Company
Address / Tel. #
Employment Date: From
Position at Start
Status of Appointment
Job Description

Reason for Leaving

Nature of Business
Immediate Superior
To
Position at Leaving
Leaving Salary

Honors/Distinction Received

If you need extra space to complete this form, use a separate sheet of paper.

Application Form . P2

TRAINING AND SEMINAR

Training and Seminar Attended

Inclusive Period

No. of Training Hours

Conducted by

CIVIL SERVICE ELIGIBILITY (INCLUDING BAR OR BOARD EXAMINATION)

Examination

Place

Date

Rating

FAMILY DATA
(Parents, Spouse, Children, Brothers and Sisters) Please put an "+" in the "age" column if family member is deceased.

BIRTH DATE

FULL NAME

AGE

mm/dd/yyyy

RELATION

PROFESSION /
OCCUPATION

WHERE EMPLOYED

1
2
3
4
5
6
7
8
9
10

MEDICAL HISTORY
Birth Mark

Allergies

Physical Defect/Major Surgery/Illness

Blood Type

Do you wear glasses / contact lenses?

Yes

No

Grade

CHARACTER REFERENCES
Give at least three (3)

Name

Position

Company/Address

Contact Number

Please List down all relatives by consanguinity or affinity to any official or employees of the Department of Energy or any attached
agency.Name of Relative(s)
Relation
Company
Occupation/Position

Have you ever been accused of indicted/tried for the violation of any law, ordinance or regulations before any court or tribunal, or
have you ever been accused/charged, or tried for any breach of infraction of military, naval or constabulary discipline in an
administrative
Yes action? No
(If yes, give the date and state the nature of offense and penalty)

Have you ever been previously retired or were you given separation pay?
Yes

No

(If yes, please indicate amount ___________________ )

In case of emergency, who should we notify? Name

Address:

Relation
Phone No.

ALL INFORMATION I HAVE SUPPLIED IN THIS APPLICATION ARE TO THE BEST OF MY KNOWLEDGE, TRUE AND CORRECT.
I UNDERSTAND THAT THIS AUTHORIZES THE MANAGEMENT OF THE DEPARTMENT OF ENERGY TO CONDUCT BACKGROUND
CHECK / VERIFICATION RELATIVE TO THIS APPLICATION. I UNDERSTAND FURTHER THAT ANY DELIBERATELY UNTRUE
INFORMATION OR
FALSE STATEMENT GIVEN HERE WILL BE SUFFICIENT CAUSE OF DISQUALIFICATION OF MY APPLICATION AND CAN BECOME
A BASIS FOR MY DISMISSAL (IF AND WHEN HIRED).

Printed Name and Signature

Rev No/ Rev Date: 2 / July 8, 2016

Date