1.

Who are your family members/relatives/friends now working with any newspaper/magazine/print
media/advertising firm or agency/TV or radio office/station?
Name Relation Residence Position Firm Connected & Address
________________ __________ ______________ ___________ _____________________________
________________ __________ ______________ ___________ _____________________________
________________ __________ ______________ ___________ _____________________________
________________ __________ ______________ ___________ _____________________________

2. If single, how soon are you getting married? In _______years _______months

3. Fiancé/Boyfriend/Girlfriend
Position Company Connected Philippines or Abroad
__________________ ____________________________ __________________________________

4. When you are working in a company, will you give or furnish important matters of confidential
information concerning the company when asked by your parents, family members, relatives or close
friends? Yes_______ No_______
Reason______________________________________________________________________________
____________________________________________________________________________________

5. After you are accepted and already working in our company, if you receive an offer from another
company offering you a higher position or bigger salary, will you transfer to the other company?

Yes_______ No_______
Reason______________________________________________________________________________
____________________________________________________________________________________

6. After you started working with us, is there any possibility:

(a) that you may start your own business? Yes_______ No_______
Reason___________________________________________________________________________
_________________________________________________________________________________
(b) that your parents or relatives may need you to assist or work for them?
Yes_______ No_______
Reason___________________________________________________________________________
_________________________________________________________________________________

7. If you are working in a company, in case of any conflict between Management and the Union, will you
side with the Management?_______ or Union?_______
Reason______________________________________________________________________________
____________________________________________________________________________________

8. In case you pass all examinations/interview and you are accepted for employment, can the Company
always rely on your honesty, integrity, loyalty and consider you as an asset to the Company?
Yes_______ No_______
Reason______________________________________________________________________________
____________________________________________________________________________________

Manila, ________________________ ____________________________________

Date Print full name and sign in full
FORM 5189
Please accomplish clearly in your own handwriting.
Date: _________________ Affix 2" x 2"
INFORMATION SHEET
Sirs:
I have the honor to apply for the position as temporary Photo
______________________________ or any suitable Position
in your company. In this connection, I hereby submit the
following data and information, to wit:

1. NAME___________________________________________________________________________
(PRINT) LAST FIRST MIDDLE NICKNAME
2. T.I.N.:____________________________ S.S.S. No. ______________________________________
3. Age:_____ Height:_____Ft._____In. Weight_____lbs. Distinguishing Marks: ________________
4. Sex:_____ Civil Status:____________________ Citizenship:_______________________________
5. Place of Birth:________________________________ Date of Birth: _________________________
6. Provincial Address:____________________________ Tel.: ________________________________
7. Present Address:______________________________ From: _______________To______________
Since when?__________________________________ Tel.: ________________________________
Business Address:_____________________________ Tel.:_________________________________
8. Who recommended you to this company? _______________________________________________
Occupation:________________ Address: _______________________________________________
9. Name Place of Birth Age Occupation Office connected & Address
Father______________ _____________ _____ ____________ _________________________
Mother_____________ _____________ _____ ____________ _________________________
Grandfather _________ _____________ _____ ____________ _________________________
(Father side)
Grandmother ________ _____________ _____ ____________ _________________________
(Father side)
Grandfather _________ _____________ _____ ____________ _________________________
(Mother side)
Grandmother ________ _____________ _____ ____________ _________________________
(Mother side)
Father-in-law________ _____________ _____ ____________ _________________________
Mother-in-law_______ _____________ _____ ____________ _________________________
Spouse_____________ _____________ _____ ____________ _________________________
Spouse's Previous Employment(s):
Name of Firm Address Position Salary Length of Service
______________________ __________________ ____________ _______ From_____To_____
______________________ __________________ ____________ _______ From_____To_____
10. Educational Attainments:
Elementary School______________________ Year Graduated______________ Rating__________
High School____________________________Year Graduated______________Rating__________
College _______________________________ Degree Earned______________________________
Year Graduated___________Rating________ Honor Received_____________________________
Other Courses_____________________________________________________________________
Board Examination ______________________ Year Passed_________________Rating__________
License/Registration No.__________________ Date Issued_________________________________
Issuing Authority __________________________________________________________________

_____________________________
Full Signature
 Page 2

Language/Dialects Spoken___________________________________________________________
Other Qualifications________________________________________________________________
Do you plan to further your studies? ____________________________________________________
Are you a Reservist/Retired member of the Armed Forces of the Philippines? ___________________
What office machine/equipment/computer can you operate? _________________________________
________________________________________________ Can you drive?____________________
Typing speed _________________words/min. Shorthand speed _________________words/min.
11. Do you have any personal or other business interests/investments with any firm or persons? If so, please
indicate details_______________________________________________________________
Do you have plans of migrating to another country? _______________________________________
12. Kind of work most interested_________________________________________________________
13. In what other line of service can you be useful? ___________________________________________
What are your hobbies? _____________________________________________________________
14. Are you a habitual gambler? _____________ If so, what kind? _______________________________
Have you ever been accused/convicted of any crime? ______________________________________
If so, give particulars________________________________________________________________
15. Are you living alone? _________ With Family? _________ Relatives? _________ Friends? ________
Who owns the house you are living? ___________________________________________________
Are you renting the house? ____________ Apartment? ____________ Boarding? ____________
Board & Lodging? ____________ How much per month? P________________
If single, how much is your total monthly expenses? P________________
If married, including children, how much is your total monthly expenses? P________________
How much minimum monthly salary/allowance do you expect? P________________
If living other than immediate family members, please indicate:
Name Position Firm/Office Connected Address
____________________ _________________ ____________________ ___________________
____________________ _________________ ____________________ ___________________
____________________ _________________ ____________________ ___________________
____________________ _________________ ____________________ ___________________
16. Who are your relatives now working with any commercial/savings/rural banks financial/investments
firms?
Name Relation Residence Position Bank/Firm Connected/Address
______________ _____________ ____________ __________ __________________________
______________ _____________ ____________ __________ __________________________
______________ _____________ ____________ __________ __________________________
______________ _____________ ____________ __________ __________________________
17. Present Employment:
Name of Firm Address Position Salary Length of Service
__________________ ___________________ ______________ _______ From______To_____

_____________________________
Full Signature
 Page 3

18. Previous Employment(s):

Name of Firm Address Position Salary Length of Service
____________________ ___________________ ______________ _______ From______To_____
____________________ ___________________ ______________ _______ From______To_____
____________________ ___________________ ______________ _______ From______To_____
____________________ ___________________ ______________ _______ From______To_____
Reasons for leaving your last employment(s)_____________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How did your boss or superior treat you during your employment?
Good?_____________________ Fair?_____________________ Bad?______________________
19. How long can you continue working with the company?
Trial________ Temporary________ Number of months________ Number of years________
As long as my services are needed by the company________________________________________
Are you willing to be transferred from one Department/Branch to another Department/Branch at the
discretion of Management?Yes________ No________
20. Membership in associations, labor and/or civic organizations:
Name of Organization Position Held Length of Membership
______________________________ ______________________ __________________________
______________________________ ______________________ __________________________
______________________________ ______________________ __________________________
21. Seminars, workshops or special courses attended:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
22. Institutions/Training Organizations:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

23. Name of ten (10) persons connected with private commercial firms or entities whom you or your family
know well or who could vouch for your honesty, integrity and loyalty:
Name Firm Connected Position Office Address
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________

_____________________________
Full Signature
 Page 4

24. Name of ten (10) government officials or employees whom you or your family know well or who could
vouch for your honesty, integrity and loyalty:
Name Firm Connected Position Office Address
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________
___________________ ___________________ ________________ ________________________

25. Name of Children/Dependent Age Relation Occupation Office/Firm Connected/Address

_________________________ _____ __________ ____________ __________________________
_________________________ _____ __________ ____________ __________________________
_________________________ _____ __________ ____________ __________________________
_________________________ _____ __________ ____________ __________________________
_________________________ _____ __________ ____________ __________________________

26. Number of Brothers:__________ Number of Sisters:__________

Name Age Residence Occupation Office/Firm Connected/Address
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________

27. Number of Uncles:__________ Number of Aunts:__________

Name Age Residence Occupation Office/Firm Connected/Address
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________

_____________________________
Full Signature
 Page 5

28. Number of Nephews:__________ Number of Nieces:__________

Name Age Residence Occupation Office/Firm Connected/Address
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________

29. Number of Brothers-in-law:__________ Number of Sisters-in-law:__________

Name Age Residence Occupation Office/Firm Connected/Address
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________

30. Number of Uncles-in-law:__________ Number of Aunts-in-law:__________

Name Age Residence Occupation Office/Firm Connected/Address
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________
___________________ _____ ______________ ______________ __________________________

31. State briefly your five-year career plan:

1st year __________________________________________________________________________
2nd year _________________________________________________________________________
3rd year _________________________________________________________________________
4th year __________________________________________________________________________
5th year __________________________________________________________________________

32. Other information: _________________________________________________________________

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

_____________________________
Full Signature
 Page 6

I HEREBY CERTIFY on my honor the answers I have made in pages 1 to 7 inclusive of this
Information Sheet are true and correct and that there are no misinterpretations, falsification or willful
omissions therein. I authorize the company to contact and verify the accuracy and completeness of the
information contained herein. I agree to submit myself to the physical/medical examinations which may be
required by the management. I further state that I am not, and I have never been and will never be a member
or connected with any organization which advocates the overthrow of the government of the Republic of the
Philippines. I undertake to notify the company in writing seven (7) days from the date for any changes in this
Information Sheet.
It is of course understood that if my application is accepted, my employment is temporary in nature
and may be terminated at your option.

_____________________________
Full Signature

REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) S.S.
SUBSCRIBED AND SWORN to before me at ________________________________________ this
______________ day of ___________________, 20_______; affiant exhibited to me his/her Community
Tax Certificate No. A & B ______________________________ issued at
______________________________ on ____________________, 20________.

Notary Public
Until December 31, 20____

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of 20_________.