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4A SPES Application Form 2 v.2022

The document is an application form for the Special Program for Employment of Students (SPES) in the Philippines. It collects personal information such as name, date of birth, contact details, education history, and parental income/employment information. Applicants must submit documents to prove age, income status, student/out-of-school youth status, and average passing grades or certification.

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romelio salumbides
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37 views1 page

4A SPES Application Form 2 v.2022

The document is an application form for the Special Program for Employment of Students (SPES) in the Philippines. It collects personal information such as name, date of birth, contact details, education history, and parental income/employment information. Applicants must submit documents to prove age, income status, student/out-of-school youth status, and average passing grades or certification.

Uploaded by

romelio salumbides
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SPES Form 2

REPUBLIC OF THE PHILIPPINES


DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. IV-A (CALABARZON)
PUBLIC EMPLOYMENT SERVICE OFFICE
______________________________
City/Municipality/Province
SPECIAL PROGRAM FOR EMPLOYMENT OF STUDENTS
(RA 7323, as amended by RAs 9547 and 10917)

Control No.: __________________


APPLICATION FORM
By accomplishing this form, you signify your acceptance to provide pertinent and personal information about you. In compliance with Republic Act
10173 otherwise known as the Data Privacy Act of 2013, all information that will be collected through this form will be used for the sole purpose of
fulfilling the functions of this Office.
SURNAME FIRST NAME MIDDLE NAME GSIS BENEFICIARY/RELATIONSHIP

DATE OF BIRTH: (mm/dd/yyyy) PLACE OF BIRTH: CITIZENSHIP:


Passport Size Picture
CONTACT DETAILS/CELPHONE NO.: EMAIL ADDRESS: (3.5cm x 4.5 cm)

SOCIAL MEDIA ACCOUNT (FACEBOOK, TWITTER, INSTAGRAM, ETC.)

STATUS SEX ❑ Student ❑ ALS student


❑ Single ❑ Married ❑ Widow/er ❑ Separated ❑ Male ❑ Female ❑ out-of-school (OSY)
CURRENT STATUS OF PARENTS: ❑ Living together ❑ Solo Parent ❑ Separated ❑ Person With Disability ❑ Senior Citizen
❑ Sugar Plantation Worker ❑ Indigenous People ❑ Displaced Worker (1) ❑ Local (2) ❑ OFW
❑ Rebel Returnee ❑ Victims of Armed Conflicts
PRESENT ADDRESS:

PERMANENT ADDRESS:

FATHER’S NAME /CONTACT NO.: MOTHER’S MAIDEN NAME/CONTACT NO.:

OCCUPATION: OCCUPATION:

EDUCATION NAME OF SCHOOL DEGREE EARNED/COURSE YEAR/LEVEL DATE OF ATTENDANCE


Elementary
Secondary
Tertiary
Tech-Voc
DOCUMENTARY REQUIREMENTS:
(Original and other documents, when applicable, should be presented for validation)
[ ] 1) Photocopy of Birth Certificate or any document indicating date of birth or age (age must be 15-30)
[ ] 2) Photocopy of the latest Income Tax Return (ITR) of parents/legal guardian OR certification issued by BIR that the
Parents/guardians are exempted from payment of tax OR original Certificate of Indigence OR original Certificate
of Low Income issued by the Barangay or DSWD/CSWD where the applicant resides; and
[ ] 3) For students, any of the following, in addition to requirements no. 1 and 2:
[ ] a) Photocopy of proof of average passing grade such as (1) class card or (2) Form 138 of the previous semester
or year immediately preceding the application; OR
[ ] b) Original copy of Certification by the School Registrar as to passing grade immediately preceding
semester/year if grades are not yet available
[ ] 4) For Out of School Youth (OSY), original copy of Certification as OSY issued by DSWD/CSWD or the authorized
Barangay Official where the OSY resides, in addition to requirements no. 1 and 2.
SPECIAL SKILLS:

HISTORY of SPES Availment/ Name of Establishment YEAR SPES ID NO. (if applicable)
st
[ ] 1 Availment
[ ] 2ndAvailment
[ ] 3rdAvailment
[ ] 4thAvailment
Other related information/ requests/ interventions from DOLE:

I hereby attest that the information above is true and correct to the best of my knowledge, including the attached documents / requirements
which I also attest as to their veracity. I agree that any false statement would cause the automatic disqualification/ cancellation of the service/
contract/ grant and I shall refund amount received and/or pay damages to DOLE or comply with other sanctions in accordance with law. Any
material change in my financial status may affect my eligibility to continue the program.

____________________________________
Signature of Applicant

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