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FM LR 005 DO18 A Application Form

This document is an application form for registration of job contractors/subcontractors with the Department of Labor and Employment in the Philippines. It requests information such as the business name and address, contact details, areas and industries of operation, number of employees, names and positions of officers, list of current clients, and an undertaking to abide by all applicable labor laws and regulations. The applicant must fill out this form in triplicate and submit it to the relevant DOLE Regional Field Office where the business is located.

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685 views2 pages

FM LR 005 DO18 A Application Form

This document is an application form for registration of job contractors/subcontractors with the Department of Labor and Employment in the Philippines. It requests information such as the business name and address, contact details, areas and industries of operation, number of employees, names and positions of officers, list of current clients, and an undertaking to abide by all applicable labor laws and regulations. The applicant must fill out this form in triplicate and submit it to the relevant DOLE Regional Field Office where the business is located.

Uploaded by

Natura Manila
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form No.

1
Republic of the Philippines
Department of Labor and Employment
REGIONAL OFFICE NO. IV-A

APPLICATION FOR REGISTRATION OF JOB CONTRACTORS/SUBCONTRACTORS

1. Business Name: ___________________________________________________TIN__________________


2. Business Address: _____________________________________________________________________
3. Telephone No. __________________________Fax: _________________Email: ____________________
4. Contact Person and Position: ____________________________________________________________
5. Areas of Operation: ___________________________________________________________________
6. Nature of Business: _________________________ 7. Industries to be covered____________________
8. Number of Regular Workers: ______ Male: _____ Female: ______
9. Names, Positions and Addresses of Officers and Staff:

Names of Officers/Staff Position Postal Address

10. List of Clients (use additional sheet if necessary)


Number of Employees
Name and Address of Nature of Services Provided Description of the Covered in each Phase of the
Client/Principal Business to Clients/Principal Phase of the Contract Contract
Male Female

11. UNDERTAKING:
That I, ____________________, Filipino, of legal age, _____________________, ___________________
name civil status position

Of _______________________________________, after having been duly sworn to in accordance with law, do


name of company

hereby depose and say:


1. That our company shall abide by all applicable laws and regulations of the Department of Labor and
Employment;
2. That the remittances to SSS, HDMF, Philhealth, ECC and BIR will be paid religiously by the company.
In witness whereof, I have hereunto affixed my signature this __ day of ________ 20__ in
____________________________________

_______________________________
(Affiants Name /Signature)

SUBSCRIBED AND SWORN to before me this ___day of ________2014. Affiant exhibited to me his/her
Residence Certificate No. ____________, issued at _________ on ___________.
Doc. No. __________
Page No. __________
Book No. __________
Series of __________

Note: All contracts entered into after this registration shall be reported to the DOLE Regional Office on or before the 10th day
of the month immediately following the date of entry into contract.

FM-LR-005
Effective 09/21/15
Instructions in Accomplishing Form No. 1

APPLICATION FOR REGISTRATION OF JOB CONTRACTOR/ SUBCONTRACTOR

This form shall be accomplished by the contractor/sub-contractor in triplicate and


submitted to the DOLE Regional Field Office having jurisdiction on the place of the
contractors/sub-contractors main office.

1. Business Name
Enter the business name of the contractor/subcontractor registered with the SEC, DTI,
CDA, or DOLE.
2. Business Address
Enter the business address of the contractor/sub-contractor
3. Telephone No.
Enter the telephone number(s) of the contractor/sub-contractor.
4. Contact Person/Position
Enter the name of the President or General Manager or any other officer of the
company who can provide information on the entries. Indicate the position of the
officer.
5. Areas of Operation
Enter or enumerate the area(s) or places covered by the contractor/ subcontractor.
6. Nature of Business
Indicate the kind of business the contractor/sub-contractor is engaged in i.e., janitorial
services, messengerial, trucking services, etc.
7. Industries to be covered
Indicate the kind of industries of the clients/prospective clients to be covered.
8. Number of Regular Workers/Male/Female
Enter the number of regular workers of the contractor/sub-contractor broken down into
male and female.
9. Names, Positions, and Address of Officers/Staff
Enumerate the names of the officers and staff of contractors/sub-contractor, their
respective positions in the company and their respective home addresses. This does
not include the names of the workers to work with the principal. Additional sheet may
be used if necessary.
10. List of Actual Clients
Enumerate the name(s) and addresses of the clients with which the contractor/sub-
contractor have existing contracts, its nature of business, services to be provided to the
client, number of personnel assigned to each client, description of each phase of the
contract, the number of employees covered in each phase of the contract,
disaggregated into male and female.
11. Undertaking
Indicate the needed information in the blank spaces provided in the undertaking.

The signature of the President or General Manager and the date of signing
should appear in the designated portion of the form.

FM-LR-005
Effective 09/21/15

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