“WR EMPLOYMENT CONSULTANTS AND MULTI-SERVICES, INC. HOW DID YOU FIND US? (PLEASE CHECK) Newspaper CiRadio OFiyer Walk-in Referred by: Others: neue Postions appied or deur ‘APPLICATION for EMPLOYMENT] | 0°5"ed Salary eae AFFIDAVIT of DECLARATION 252 caren piers TastName pee idle Namie Sex] Ghar Saius | Age] Bireay Giizenship | Feight | Weight | Religion PASSPORT DETAILS No, Plage of issue Date of issue: gi EDUCATIONAL BACKGROUND NAME OF SCHOOL MaiorDegre Ireusve years] yardaiCetiicatloners Post Graduate Cotege | High Sehoo! | Elementary | | PROFESSIONAL LICENSES, CERTIFICATES & SPECIAL SKILLS Profession ID No [ date Passed Rating Certificates: lEnglish proficiency C1 skis proficiency others: Other Special Skills: Can UselOperate: O) Computer CiFax machine Cother machine/equipment (specify): EMPLOYMENT HISTORY (IST MOST RECENT POSITIONS FIRST) ‘Name of Employer Employing company Address Date of Employment | From To Poslion/Deparment Description of Major Duties (use additonal paper fnecessar) Reason for leaving: ‘Name of EmployerfEmploying company Tadaress Date of Employment | From To Posiion-Department Description of Major Dutes (use adcitonal paper ifnecessary) Reason for leaving’ ‘Name of EmployerfEmpioying company ‘Aaaress Date of Employment | From Positon/Deparment ‘Description of Major Duties (use additional paper iinecessary) Reason or leavingPROFESSIONAL REFERENCES (Preferably previous Supervisors or Managers) Name Position Company and Email Address ‘Are you now employed? C) yes _L}_No_Does your present employer know you are applying for this job? 2) ves) No Would you allow Background investigation? _[J_Yes Ono PERSONAL DATA. | Giy Adcress ] iy Phone No ‘ice Phone No. Proving AdaressIBih Place Provincial Phone No Tobie We Father's Name ge] Oosupaion Tareas Mothers Name poate are Tareas Spouse ge | Oszupation across Children (From eldest to youngest) i Age | Occupation Access 5 Tigo | Seapaion nares 5 Age | Occupation address iB 3 Tage | O=¥eat07 | Rares "ADDITIONAL EMPLOYMENT RECORD (Answer the following truthfully and objectively) 4. Have you been foribly-reptriated or deported from ancther county. previously?” Cl Yes No if yes, whien countries? When? Reasons for fered epaiain/doporaion = 2, Have you fled o insted any legal acon or complaint agaist any ofthe folowing eniies? Cl ves Cl No ‘orig Employer == Supensororfelow worker — ~~ Plcarent agency abroad —~-Phlippne resumen sg696 Feason for fing or ting eal sionlompain Assisted ladvised by: lawyer Cl ChurehiReligious group. Non-Govt Org (NGOUGivi Society Group (C50). Labor courts where gal con was fled or nti Case Nurbe nd OutomelSatus of legs acon complaint ed DECLARATION & CERTIFICATION | Thereby declare that | was clearly advised by the Agency to deal only with authorized Company personnel. Specifically, | was told that when making payments, | should only pay amounts that are authorized by law, and that | should pay only to the authorized Cashier or Accounts staff ofthe company. ‘That | should submit copy of my application documents and certificates, as part of the job application process. Said photocopies become the agency's files and cannot be withdrawn hereafter. That | should present original documents and certificates for verification purposes, and/or when | am selected for employment where original qualification documents and certificates are required by the agency or its client, for visa application/travel clearance processing and mobilization. I hereby certify that all information and data | have provided herein, are true and correct. | am aware that if proven to have misrepresented, falsified information or have provided erroneous data to my agency or its clients, such may cause the rejection of, | my application and the eventual filing of a case for disciplinary action against myself, by the agency or its client, for reasons of | document-faciltation and misrepresentation, | hereby authorize the agency/company to contact the references given above for background checking and other legal purposes. | hereby further authorize the agency/company to use or submit my application form as it sees fit or proper to any partes for the purpose of obtaining employment for me. Inwitness whereof, | hereunto signed this form, in the City of . Philippines. ‘Signature over Printed Name Date ‘SUBSCRIBED AND SWORN TO before me this _day of 2023 in the City of Manila | Dos. No. Page No. | Book No. ‘Sories of 2023, NOTARY PUBLIC [nSOTHER INFORMATION a BENEFICIARIES 3 Name Birthday | Relationship TelephoneiMobie Nos. PERSONS TO BE CONTAGTED IN CASE OF EMERGENCY Name ‘Across Relationship TelephoneiMoble Nos HER TRUTHFUL DECLARATION FROM JOB APPLICANT-WORKEI 4. My most positive traits that woul contribute to the success of my Employer's business are 2. Leonfirm thatthe purposes of my job application (locally or abo), are: Primary reasons: | ‘3. Thus, | intendiplan to work with my Employer for} _months C21 year Od 2years C1 for as iong as Employeriproject needs me ‘4. Meantime, what could possibly make me go back home earlier than my contract expiration, ae: Signat ‘over Printed Ni Date Note : For non-akilledinon-professional applicants 10, household service po: ns), an “Annex-A” of this Form, lable EVALUATION = (FOR OFFICE USE ONLY) ‘Actual | Verbal Postion Education eckaal., | Yerba! [ personality | — Heath OwralRaing | : | | | fas Togend | E+ Excelent VO= Very Good Farar Poor Conon | [interviewer's Name: Postion: Date of interview: