PMD-FO303-01-002_7.1.2 Rev.

01

APPLICANT INFORMATION SHEET

Please fill up this form completely. If the question does not apply to you, write N/A. Do not leave any blank unanswered.

First Choice
Date of application Position desired
Second Choice

Personal Information

Name:
____________________________________________________________________________________________________________________________________________________________________________
Last First Middle Nickname

Current Address:
__________________________________________________________________________________________________________________________________________________________________________

Previous Address:
___________________________________________________________________________________________________________________________________________________________________________

E-mail address:
__________________________________________________________________________________________________________________________________________________________________________

Preferred Contact Nos.:

_________________________________________________________________________________________________________________________________________________________________________
Home Office Mobile

Educational Background
Level School/University Course Inclusive Dates Awards/Honors
Graduate 1

Graduate 2

College 1

College 2

High School

Others

Professional Organizations Affiliation Position Occupied Inclusive Years

Non-Professional Organizations Affiliation Position Occupied Inclusive Years

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Skills Information
Tools, Software and/or
Please list any technical skills or expertise that you possess Years of practice
Machines Used

1.

2.

3.

Tools, Software and/or

Please list down any special projects you have undertaken in the last 3 years Project Duration
Machines Used
1.

2.

3.

Please list down languages and dialects that you can speak and/or write Proficiency Level
Please check appropriate box

1.  Excellent  Fair

2.  Excellent  Fair

3.  Excellent  Fair

Professional License Date Issued Expiry Status

1.

2.

Government Examination Date Issued Expiry Status

1.

2.

Employment History (Please start from most recent.)

Immediate
Employer 1 Supervisor

Salary
Nature of Business Service Period
Received

Address and Contact Reason for

Information Leaving

Key
Position
Responsibilities

Immediate
Employer 2 Supervisor

Salary
Nature of Business Service Period
Received

Address and Contact Reason for

Information Leaving

Key
Position
Responsibilities

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 Immediate
Employer 3 Supervisor

Salary
Nature of Business Service Period
Received

Address and Contact Reason for

Information Leaving

Key
Position
Responsibilities

Immediate
Employer 4 Supervisor

Salary
Nature of Business Service Period
Received

Address and Contact Reason for

Information Leaving

Key
Position
Responsibilities

Immediate
Employer 5 Supervisor

Salary
Nature of Business Service Period
Received

Address and Contact Reason for

Information Leaving

Key
Position
Responsibilities

Family Information (Please give particulars about your parents, siblings, spouse (if married), and children.)
Name Relationship Employer/Address/Contact Nos. Position Age

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

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Additional Personal Data

Date of Birth: _____________________________________ Age: __________________ Gender: _____________________ Place of Birth: ________________________

Civil Status: ________________________________________ Religion: ____________________________________________ Citizenship: __________________________

Social Security No.: ________________________________ TIN: _________________________________________________ Philhealth ___________________________

Person To Contact In Case of Emergency: _______________________________________________________________________________________________________

Phone No. To Contact In Case of Emergency: ____________________________________________________________

Hobbies/Interests:

Are you currently or were you involved in any consulting work? Were you paid for doing work on a per project basis? If so, please state
name of Company and nature of work.

Do you intend to continue doing so if hired by II-VI PMD? Why?

Are you related to any present officer or staff member of II-VI PMD? If yes, please indicate the name and relationship.

Approximate monthly minimum salary expected. If employed, how soon can you begin?

Have you ever been involved with any administrative, civil or criminal cases? Please specify.

Have you had any physical or mental condition which limits your ability to perform the job applied for or poses a potential risk to other
employees? Please specify.

References (Please indicate at least three.)

Name Occupation/Employer Contact Information

APPLICATION AGREEMENT

If employed by II-VI Performance Metals, Inc. (II-VI PMD), I agree to provide the company with school transcripts and other
necessary documents. I understand that employment with II-VI PMD is contingent upon several factors, including
satisfactory information resulting from a background and reference check to which I authorize II-VI PMD to conduct.

All representations by me in this data sheet are true and correct to the best of my knowledge and belief, and I have not
knowingly omitted any related information of an adverse nature. Inaccurate information may make me ineligible for
employment.

This application form does not serve as a contract for employment. Employment is at will.

Applicant’s Signature Over Printed Name: __________________________________________________Date: ____________________________

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