PERSONAL INFORMATION

Last Name GOMEZ Suffix (ex. Jr.)

First Name MARVILOU Middle Name MONDEJAR

Maiden Name Position Applied For
EHS SPECIALIST
(if applicable) (if applicable)
Date of Birth 11/16/1991 City of Birth SAN JOSE , BATANGAS Citizenship FILIPINO

Gender Male ☐ Female ☒ Civil Status Single ☒ Married ☐ Separated ☐ Widowed ☐

Telephone Email
Mobile Number 09289744278 marvilougomez@gmail.com
Number Address
SSS # 04-29893610 PhilHealth # 01-051982017-5

TIN 458-600-390 HDMF/Pag-IBIG #

Passport # Driver’s License #

Current Address Blk 258, Lot 8 Brgy. Pembo

Years
City Makati Country Philippines 1
Resided
Permanent Address Brgy. Catandala
Years
City Ibaan, Batangas Country Philippines 20
Resided
Previous Address 1313 San Andres Street Malate
Years
City Manila Country Philippines 3
Resided
Mother’s Name Contact
Marivic T. Mondejar
(Maiden) Number
Contact
Father’s Name Jesus B. Gomez
Number
Contact
Spouse’s Name N/A
Number
Contact
Brother’s Name Salvador M. Gomez
Number
Contact
Sister’s Name
Number
Have you worked for this company If so, what company
YES ☐ NO ☒
and/or its known affiliates? and when?
Have you ever been accused, indicted If yes, please briefly
YES ☐ NO ☒
and/or convicted of any crime? explain.
Do you have any disability or illness at If yes, please briefly
YES ☐ NO ☒
the present time? explain.
DECLARATION OF AUTHORIZATION AND CONSENT
I, ___________________________, authorize ICONIC Core Global Inc., and outside entities of the company’s choice as my “Personal Information
Controller and Processor” under the Data Privacy Act of 2012 to collect information pertaining to myself on my behalf from the day of signing this form.

I fully permit the release of all my information to ICONIC Core Global; to verify and check the information obtained and gathered, and shall be for the
exclusive use of InterGlobe Technologies only and shall be strictly held in confidentiality from any persons and/or organizations without my consent.

I hereby state that all information I have provided to ICONIC Core Global Inc. and its known affiliates, in any form, is true to the best of my knowledge. I
understand that any false statement, omission of facts or any known misrepresentation made to ICONIC Core Global and/or its known affiliates may
cause my possible exclusion or disqualification from further consideration as a candidate. Likewise, I understand that my personal information, education,
professional work experience and/or association, character references and other activities provided herewith and verified are not the only basis for my
successful employment, transfer or promotion against other criteria set by management.

Printed Name and

Date
Signature

Unit I - 4F Westgate Tower, Investment Drive, Madrigal Business Park, Ayala Alabang, Muntinlupa City, Philippines
Office: +632 835 55 08 | Email: info@iconicglobal.ph | Website: www.iconicglobal.ph
ICONIC Core Global, Inc.
 EDUCATION
High School Completed? YES ☐ NO ☐

Location/Address
Graduation Student
Dates of Attendance From To
Date Number
University/College
Specific
Location/Address
☐ Post-Graduate ☐ Bachelor’s Degree YES ☐ If not, indicate
Level of Attainment Graduated?
☐ Associate Degree ☐ Non-Bachelor’s/Vocational NO ☐ year level
Course/Program
Total Number of Units
Grade/GWA/Honors
Earned (if applicable)
Graduation
Dates of Attendance From To
Date
University/College
Specific
Location/Address
☐ Post-Graduate ☐ Bachelor’s Degree YES ☐ If not, indicate
Level of Attainment Graduated?
☐ Associate Degree ☐ Non-Bachelor’s/Vocational NO ☐ year level
Course/Program
Total Number of Units
Grade/GWA/Honors
Earned (if applicable)
Graduation
Dates of Attendance From To
Date
Others
Specific
Location/Address
☐ Post-Graduate ☐ Bachelor’s Degree YES ☐ If not, indicate
Level of Attainment Graduated?
☐ Associate Degree ☐ Non-Bachelor’s/Vocational NO ☐ year level.
Course/Program
Total Number of Units
Grade/GWA/Honors
Earned (if applicable)
Dates of Attendance Graduation
From To
Date
DECLARATION OF AUTHORIZATION AND CONSENT

I, ___________________________, authorize the above listed educational institutions, any educational institutions listed on my résumé, or
those institutions discovered during the course of my background check to release the above mentioned information to ICONIC Core Global. I understand
that I fully permit ICONIC Core Global to collect information regarding my education and other relevant information.

Printed Name and

Date
Signature

Unit I - 4F Westgate Tower, Investment Drive, Madrigal Business Park, Ayala Alabang, Muntinlupa City, Philippines
Office: +632 835 55 08 | Email: info@iconicglobal.ph | Website: www.iconicglobal.ph
ICONIC Core Global, Inc.
 EMPLOYMENT
Current Employment
Do we have your permission to contact your current employer? YES ☐ NO ☐

Company Name Contact Number

Agency Name
Were you employed or placed via agency? YES ☐ NO ☐
(if applicable)
Location/Address
Dates of Future End Date Supervisor/Manager
Start Date
Employment (if applicable) Name
Supervisor/Manager
Job Title
Contact Information

Previous Employment
Company Name Contact Number
Agency Name
Were you employed or placed via agency? YES ☐ NO ☐
(if applicable)
Specific
Location/Address
☐ Probationary
Employment Dates Start Date End Date
☐ Regular
Employment Status ☐ Contractual
☐ Project-Based
Job Title
☐ Others: _____________

Supervisor/Manager Supervisor/Manager
Name Contact Information
Reason for Leaving

Company Name Contact Number

Agency Name
Were you employed or placed via agency? YES ☐ NO ☐
(if applicable)
Specific
Location/Address

☐ Probationary
Employment Dates Start Date End Date
☐ Regular
Employment Status ☐ Contractual
☐ Project-Based
Job Title
☐ Others: _____________

Supervisor/Manager Supervisor/Manager
Name Contact Information
Reason for Leaving

Company Name Contact Number

Agency Name
Were you employed or placed via agency? YES ☐ NO ☐
(if applicable)
Specific
Location/Address

Unit I - 4F Westgate Tower, Investment Drive, Madrigal Business Park, Ayala Alabang, Muntinlupa City, Philippines
Office: +632 835 55 08 | Email: info@iconicglobal.ph | Website: www.iconicglobal.ph
ICONIC Core Global, Inc.
Employment Dates Start Date End Date ☐ Probationary
☐ Regular
Employment Status ☐ Contractual
☐ Project-Based
Job Title
☐ Others: _____________

Supervisor/Manager Supervisor/Manager
Name Contact Information
Reason for Leaving

Company Name Contact Number

Agency Name
Were you employed or placed via agency? YES ☐ NO ☐
(if applicable)
Specific
Location/Address
☐ Probationary
Employment Dates Start Date End Date
☐ Regular
Employment Status ☐ Contractual
☐ Project-Based
Job Title
☐ Others: _____________

Supervisor/Manager Supervisor/Manager
Name Contact Information
Reason for Leaving

Company Name Contact Number

Agency Name
Were you employed or placed via agency? YES ☐ NO ☐
(if applicable)
Specific
Location/Address

Employment Dates Start Date End Date ☐ Probationary

☐ Regular
Employment Status ☐ Contractual
☐ Project-Based
Job Title
☐ Others: _____________

Supervisor/Manager Supervisor/Manager
Name Contact Information
Reason for Leaving

DECLARATION OF AUTHORIZATION AND CONSENT

I, ___________________________, authorize the above listed employers, any employers listed on my résumé, or those employers
discovered during the course of my background check to release the above mentioned information to ICONIC Core Global. I understand that I fully
permit ICONIC Core Global to collect information regarding my employment and other relevant information.

Printed Name and

Date
Signature

Unit I - 4F Westgate Tower, Investment Drive, Madrigal Business Park, Ayala Alabang, Muntinlupa City, Philippines
Office: +632 835 55 08 | Email: info@iconicglobal.ph | Website: www.iconicglobal.ph
ICONIC Core Global, Inc.