PRE-EMPLOYMENT APPLICATION

ABE Data Solutions, Inc. is an equal opportunity employer and will consider all applicants for all positions equally without regard to their
race, sex, age, color, religion, national origin, veteran status or any disabilities as provided in the Americans with Disabilities Act.

This application will be given every consideration, its receipt does not imply that the applicant will be employed. Each question should be
answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

PERSONAL
Name Home Phone
LAST FIRST MIDDLE AC
Present Address

NUMBER STREET CITY ZIP BIRTHDAY

Social Security No. Philhealth Tin No. Pagibig

Person to notify in case of emergency Relationship Contact No.

Have you ever been convicted of any crime (excluding marijuana convictions that is more than 2 years old) including driving while
under the influence of alcohol or drugs (excluding minor traffic violations)? Yes No

If yes, state the offense, location, date and disposition

NOTE: A conviction will not necessarily disqualify you from employment.

Do you have the ability, with or without reasonable accommodations, to work overtime or to travel and/or overtime is required by the
job for which you are applying? Yes No
If no, please explain

Would you be willing and able to relocate? Yes No

Driver’s License: State Type Currently Valid? Yes No

EMPLOYMENT DESIRED

Are you seeking Full time Part-time Temporary or summer employment?

Position applied for Salary Desired

Date Available to start

Have you ever applied in ABE before? Yes No

Have you ever worked for ABE before? Yes No

If your answer to either of the above questions is Yes, state when you applied and/or worked.

How did you learn of ABE and/or position?

Are you now, or do you expect to be, working in any other business or jobs? Yes No

Are there any days or hours you would be unable or unwilling to work? Yes No
If yes, please specify those days or hours you would be unable or unwilling to work

ABE DATA SOLUTIONS, INC. Page 1 of 5

 EDUCATION

Name, Address and Location Dates Graduate? CoursesStudied

High School From : Yes Diploma :

To: No

College From : Yes Diploma :

To : No

Trade School From : Yes Diploma :

To : No

If you did not graduate, why did you leave high school or college?

Are you planning to pursue further studies? Yes No

If so, when, where and what courses?

List any scholastic honors, offices held and activities involved in during high school and college

List and describe any other School or Specialized Training

MILITARY

Have you ever served in the military? Yes No

Service Branch Date Entered

Date Separated Final Rank

CAPABILITY / RELIABILITY

Would you be willing and able to perform all of the tasks required by the job you are applying for? Yes No
If not, please explain which tasks

Have you filed any type of fraudulent claim against any of your present or past employers? Yes No
If yes, please explain

Will you abide by the safety rules of ABE? Yes No

Have you ever been disciplined for violating safety rules or regulations? Yes No
If yes, please explain

How many days of work (or school) have you missed in the last two years? How

many times have you been late for work (or school) in the last two years?

Would you be willing and able to report to work on time every day on a regular and consistent basis? Yes No
If no, please explain
 HISTORY

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military
service and any periods of unemployment. If self-employed, give firm name ad supply business references.
PLEASE GIVE MONTH AND YEAR. DO NOT REFERENCE YOUR RESUME.

Name of Employer Name and Title of Dates Employed Pay

Last Supervisor
From: To:
Address Starting
Mo. Mo. $
City, State, Zip Code

Telephone Ending
Nature of Business
Yr. Yr. $

AC

Title Reason for Leaving

Duties

Name of Employer Name and Title of Dates Employed Pay

Last Supervisor
From: To:
Address Starting
Mo. Mo. $
City, State, Zip Code
Ending
Telephone Nature of Business
Yr. Yr. $

AC

Title Reason for Leaving

Duties

Name of Employer Name and Title of Dates Employed Pay

Last Supervisor
From: To:
Address Starting
Mo. Mo. $
City, State, Zip Code
Ending
Telephone Nature of Business
Yr. Yr. $

AC

Title Reason for Leaving

Duties
Name of Employer Name and Title of Dates Employed Pay
Last Supervisor
From: To:
Address Starting
Mo. Mo. $
City, State, Zip Code

Telephone Ending
Nature of Business
Yr. Yr. $

AC

Title Reason for Leaving

Duties

Name of Employer Name and Title of Dates Employed Pay

Last Supervisor
From: To:
Address Starting
Mo. Mo. $
City, State, Zip Code

Telephone Ending
Nature of Business
Yr. Yr. $

AC

Title Reason for Leaving

Duties

Name of Employer Name and Title of Dates Employed Pay

Last Supervisor
From: To:
Address Starting
Mo. Mo. $
City, State, Zip Code

Telephone Nature of Business Ending

Yr. Yr. $

AC

Title Reason for Leaving

Duties

ABE DATA SOLUTIONS, INC. Page 4 of 5

 SUPPLEMENTAL EMPLOYMENT INFORMATION
If you worked in any of your previous positions under another name, please give that name(s) below: (For reference checking
purposes)
Name @ Company

Name @ Company

Are you presently employed? Yes No

If yes, may we contact your present employer? Yes No

Have you ever been fired, or asked to resign, from a job? Yes No

If yes, please explain?

Have you ever been disciplined or received verbal or written warnings for absenteeism or tardiness? Yes No

If yes, please explain?

SPECIAL SKILLS
Have you had any computer or word processing experience or training? Yes No

If yes, please describe?

What languages do you speak fluently?

Use this space below to describe why you are interested in working for ABE and to list those skills and abilities which you feel
particularly qualify you for a position with us. If you need more space, please continue on a separate sheet.

REFERENCES
Give three references, not relatives or former employees.

NAME ADDRESS PHONE OCCUPATION

AFFIDAVIT
I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind
whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect made on this application form or during
any interviews may be grounds for my immediate discharge.
I hereby authorize ABE to contact any company or individual it deems appropriate to investigate my employment
history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as
a result of this investigation. In addition, I hereby waive the right to bring any cause of action against these individuals for defamation,
invasion of privacy or any reason because of their statements.
I agree that, I am employed, I will abide by all the rules and regulations of ABE. I understand that the taking of drug and
alcohol tests, when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when
asked will be grounds for my immediate termination. I further understand that nobody in ABE is authorized to enter into any written or
verbal employment contracts with me for any definite period of time without the express written consent of the President of ABE. I
also understand that my employment is “at-will” and may be terminated by myself or by the
company at any time for any reason or nor reason at all, with or without prior notice.
Signature Date / / PRINT

ABE DATA SOLUTIONS, INC. Page 5 of 5