APPLICANT INFORMATION FORM v5.2016 Position Applied for First Choice
Date Applied Second Choice
Channel of Application
How soon can you start work?
PERSONAL DATA Last Name
First Name
Middle Name
Present Address
Permanent Address/Provincial Address
Date of Birth (*for seniority benefits and retirement factor)
Age (*for seniority benefits and retirement factor)
Place of Birth
Nick Name
Gender
[ ] Owned [ ] Rented [ ] Living w Parents [ ] Living w Relatives Mobile Phone Number
Home Telephone
Civil Status
Date of Marriage
Email Address
Place of Marriage (Church of/ Parish of/ Office of the/ House of / Barangay of/ Mosque of)
Religion
Citizenship
Nationality
Weight
Height
TIN
Tax Exempt Code
PhilHealh No.
HDMF (Pag-IBIG Fund) No.
SSS No.
Father's Full Name
Date of Birth & Age
Occupation
Employer
Mother's Full Name
Date of Birth & Age
Occupation
Employer
Spouse's Full Name
Date of Birth & Age
Occupation
Employer
CHILDREN Full Name
Date of Birth & Age
Occupation
Employer / School
Date of Birth & Age
Occupation
Employer/ School
BROTHERS AND SISTERS Full Name
EMPLOYMENT RECORD
p.2 of 3 v5.2
Name of Company
Starting Position
Current Position/Position Upon Leaving
Date Hired
Address
Telephone No.
Current salary/salary upon leaving
Date Separated
Name of Immediate Superior
Position of Immediate Superior
Reason for leaving
No. of people supervised
Name of Company
Starting Position
Current Position/Position Upon Leaving
Date Hired
Address
Telephone No.
Current salary/salary upon leaving
Date Separated
Name of Immediate Superior
Position of Immediate Superior
Reason for leaving
No. of people supervised
Name of Company
Starting Position
Current Position/Position Upon Leaving
Date Hired
Address
Telephone No.
Current salary/salary upon leaving
Date Separated
Name of Immediate Superior
Position of Immediate Superior
Reason for leaving
No. of people supervised
Name of Company
Starting Position
Current Position/Position Upon Leaving
Date Hired
Telephone No.
Current salary/salary upon leaving
Date Separated
Position of Immediate Superior
Reason for leaving
No. of people supervised
Address
Name of Immediate Superior
EDUCATIONAL BACKGROUND School & Address
Degree/Major
Years Attended (e.g. 2000-2004)
Awards and Honors Received
GRADE SCHOOL HIGH SCHOOL VOCATIONAL COLLEGE MASTERAL DOCTORATE
ONGOING STUDIES School
Units Earned
Year Begun
Title of Thesis/Dissertation
Total Course Units
Expected Date of Graduation
OTHER SPECIAL TRAININGS AND CERTIFICATION PROGRAMS COMPLETED Title of Seminar/Certification Program
Organizer
Date Completed
Date Taken
Rating
GOVERNMENT EXAMS TAKEN Type of Exam
EMPLOYMENT RECORD Professional Licensure Passed
p.3 of 3 v5.201 PRC Number
Valid Until
PROFESSIONAL AND CIVIC INVOLVEMENT Organization
Position
Date of Membership
ADDITIONAL DATA Do you have relatives or friends in University of Asia and the Pacific?
r Yes
r No
Expected Salary
If yes, please give the ff details: Name ___________________________ Relationship ____________________ Unit __________ Computer Skills (Please check your level of proficiency) l MS Word l MS Outlook l MS Excel l MS Access l MS l MS Publisher PowerPoint If employed, would you accept field work? r Yes r No Interests/Hobbies/Sports
Do you have any circumstance/considerations that might affect your employment in the University if hired (e.g. plans of migrating, further studies, health)? r Yes r No
If yes, please give details:
Have you ever been subjected to disciplinary action in any of your previous employment?
r Yes
r No
If yes, please give details: Have you ever been discharged or forced to resign from any previous employment?
r
r No
Yes
If yes, please give details: Have you ever been charged with and/or convicted of any criminal/administrative offense?
r Yes
r No
If yes, please give details: May we contact your present employer for reference? r Yes If yes / not yet, WHEN r Not yet r No
If no, state reason
CHARACTER REFERENCES Name
Occupation / Relationship
Company/Business Address
Contact Details
PERSON TO NOTIFY IN CASE OF EMERGENCY Name
Relationship
Telephone No.
Mobile No.
Address
I hereby certify, under pain of perjury, that the foregoing facts are true and correct. I voluntarily give UA&P the right to conduct whatever information verfication it may deem necessary. I likewise agree to provide any assistance the company may require in this regard. I declare that I have read and accept the Educational Principles of the University of Asia and the Pacific, and hereby declare that there is nothing in these Principles that violate my personal (intellectual, ideologiclal, and religious) beliefs and convictions.
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