SPES Form 5

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF LABOR AND EMPLOYMENT
REGIONAL OFFICE NO. III
PUBLIC EMPLOYMENT SERVICE OFFICE
Doña remedios Trinidad, Bulacan

SPECIAL PROGRAM FOR EMPLOYMENT OF STUDENTS (SPES)

(RA 7323, as amended by RAs 9547 and 10917)

PLACEMENT REPORT CUM GSIS INSURANCE COVERAGE

Name of Establishment/Employer: MUNICIPALITY OF DOÑ A REMEDIOS TRINIDAD Number of Beneficiaries: 15

Address: Pulong Sampaloc, Doñ a Remedios Trinidad, Bulacan Contact Person: Joylene Q. Sembrano
Business Activity: Local Government Unit Industry Code: Tel. No. 09175304075

SPES BENEFICIARY Occupational GSIS

ID Student/ OSY/ Total Amount to be
New/ SPES Code& Wage Rate per
N.o Age Sex Address Contact No. Dependent of Educational Level Baby Day Employment Period earned/ received as Policy No. GSIS Beneficiary
No. /Registration No. Displaced Worker Position salary/wages

LAST NAME FIRST NAME MIDDLE NAME

Daet Pulong Sampaloc, DRT,
Bulacan New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Luzviminda Castro
1 Castro Recca Luz 20 F 09754254229 Student 1st year College
Velasquez Sitio Silid, bayabas, DRT,
Bulacan New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Lucila Casimiro
2 Casimiro Joshua 18 M 09753660937 Student Senior High School
3 Cruz John Lord 21 M Bayabas, DRT, Bulacan 09534351769 Student 3rd year College New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Rosemarie Cruz
4 De Leon Lea Hernan 21 F Bayabas, DRT, Bulacan 09486944998 Student 1st year College New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Dioscora Hernan
5 Enriquez Marielle Delos Reyes 20 F Bayabas, DRT, Bulacan 09455823016 Student 2nd year College New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Margarita Enriques
Causaren Sitio Maiboy, Pulong
Sampaloc, DRT, Bulacan Spes Baby Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Bobbie Dote
6 Dote John Lloyd 20 M 09558652981 Student 1st year College
Malgarejo Sitio Kutad, Pulong
Sampaloc, DRT, Bulacan Spes Baby Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Daisyrie Fernandez
7 Fernandez Dairyll Joy 19 F 09519581081 Student 1st year College
Perez Kalye 11, Pulong Sampaloc,
DRT, Bulacan New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Rowena Nuñ ez
8 Nuñ ez Laila May 18 F 09367217006 Student 1st year College
Roque Talbak, DRT, Bulacan
New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Ma. Leonora Gurion
9 Gurion Moriah Irene 18 F 09367993835 Student Senior High School
10 Magdaong Marielle 20 F Camachile, DRT, Bulacan 09661809816 Student 2nd year College Spes Baby Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Marcel Agana
Catubig Pulong Sampaloc, DRT, Rowena Catubig
Bulacan New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00
11 Marco Charlene 22 F 09750476387 Student Senior High School
Leuterio Pulong Sampaloc, DRT,
Bulacan New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Melanie Nueva Españ a
12 Nueva Españ a Sofia Nicole 21 F 09451678662 Student 2nd year College
Junio Luciano St., Pulong Jennibeth Perez
Sampaloc, DRT, Bulacan Spes Baby Clerk 492.32 July 1-28, 2022 ₱ 9,846.00
13 Perez Jhiewel Mae 18 F 09451570932 Student 1st year College
Poblacion, Pulong
Angeles Sampaloc, DRT, Bulacan New Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Josepjine Sagana
14 Sagana Jhorence 20 M 09676597312 Student 3rd year College
Sitio Abo, Pulong Sampaloc,
Antonio DRT, Bulacan Spes Baby Clerk 492.32 July 1-28, 2022 ₱ 9,846.00 Bernardita Sarmiento
15 Sarmiento John Benedict 21 M 09653487080 Student 2nd year College

Note: This form shall be accomplished by the Public Employment Service Office to be submitted to the DOLE Regional Office at least ten (10) days prior to the date of employment.

Prepared by: Submitted by:

 SPES BENEFICIARY Occupational GSIS
ID Student/ OSY/ Total Amount to be
New/ SPES Code& Wage Rate per
N.o Age Sex Address Contact No. Dependent of Educational Level Employment Period earned/ received as Policy No. GSIS Beneficiary
No. Baby Position Day salary/wages
/Registration No. Displaced Worker
LAST NAME FIRST NAME MIDDLE NAME

MA. LEONORA R. GURION JOYLENE Q. SEMBRANO

June 21, 2022 June 21, 2022

Date Date
 SPES Form 5
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF LABOR AND EMPLOYMENT
REGIONAL OFFICE NO. III
PUBLIC EMPLOYMENT SERVICE OFFICE

SPECIAL PROGRAM FOR EMPLOYMENT OF STUDENTS (SPES)

(RA 7323, as amended by RAs 9547 and 10917)

PLACEMENT REPORT CUM GSIS INSURANCE COVERAGE

Name of Establishment/Employer: Number of Beneficiaries:

Address: Contact No.
Business Activity: _________________________________ Industry Code: _____________ Tel. No.

SPES BENEFICIARY Occupational GSIS

Student/ OSY/ Total Amount
Educational Wage Rate Employment to be earned/
No. (LAST NAME, FIRST NAME, M.I.) ID No. Age Sex Address Contact No. Dependent of
Level
New/ SPES Baby Code& Position
per Day Period received as Policy No. GSIS Beneficiary
Displaced Worker salary/wages

From:
1 (back out beneficiries)
2
(REASON TO REPLACE)
To:
1 (Replace Beneficiares)
2

Note: This form shall be accomplished by the Public Employment Service Office to be submitted to the DOLE Regional Office at least ten (10) days prior to the date of employment.

Prepared by: Submitted by:

Date Date
 SPES BENEFICIARY

No. (LAST NAME, FIRST NAME, M.I.) Application Number Employment Contract Oath of Undertaing

1 Daet 0 70448 68449

2 Velasquez 0 70511 68448

3 0 0 70447 68447

4 Hernan 0 70443 68443

5 Catubig 0 70450 68450

6 Leuterio 0 70449 68511

7 Junio 0 70512 68512

8 Angeles 0 70513 68513

9 Antonio 0 70514 68514

10 Err:509 Err:509 70516 68516

11 Err:509 Err:509 70515 68515

12 Err:509 Err:509 70517 68517

13 Err:509 Err:509 70518 68518

14 Err:509 Err:509 70519 68519

15 Err:509 Err:509 70520 68520

16 Err:509 Err:509 70521 68521

17 Err:509 Err:509 70522 68522

18 Err:509 Err:509 70523 68523

19 Err:509 Err:509 70524 68524

20 Err:509 Err:509 70525 68525

21 Err:509 Err:509 70526 68526

22 Err:509 Err:509 70527 68527

23 Err:509 Err:509 70528 68528

24 0 0

25 0 0