BACKGROUND CHECK REQUEST FORM

Please fill out the fields legibly/ printed. All information will be treated with utmost confidentiality.

Personal Information: Date: ____________________

November 20, 2021

Name of Candidate:
_________________________________________________________________________
Alvarez Nicklaus Elliot Fermil
Last Name First Name Middle Name Suf f ix/Pref ix

Position Applied: Customer Service Representative

Gender: x Male
__ __ Female Citizenship: Filipino
__
x Single __ Married Birth Date (MM/DD/YYYY): 04/25/1991
Civil Status:
__ Widowed __ Legally Separated Place of Birth: Quezon City
Landline No.: 09650746027 Email Address: [email protected]

Mobile No.: 09650746027 NBI No.: A416DNZT19-RN589303

SSS No.: 34-3181378-2 TIN No.: 312-723-106
PhilHealth No.: 01-051833217-7 HDMF No.: 1210-7307-2947
Complete Present Address: B4 L7 WEST CLASSIC GARDEN HOMES SUBD. MAPLE EXT. WEST FAIRVIEW, QUEZON CITY
Complete Permanent Address: B4 L7 WEST CLASSIC GARDEN HOMES SUBD. MAPLE EXT. WEST FAIRVIEW, QUEZON CITY
Complete Mother's Maiden Name: MILAGROS CORPUZ FERMIL Complete Father's Name: DENNIS BALDOVINO ALVAREZ

Character Reference/s (Minimum of 5 persons but not including immediate f amily members)
Company Contact Number/s
Name Designation Relationship Business Address
Name (Must be active & contactable)
RICARDO AGAPITO SPARK NZ SUPERVISOR TELETECH (083) 973 6007
Level 1 & 2, Main Mall, Robinsons Novaliches, Quirino Highway, Brgy, Novaliches, Quezon City, Metro Manila

PIO AGUILA SPARK NZ SUPERVISOR TELETECH (083) 973 6007

Level 1 & 2, Main Mall, Robinsons Novaliches, Quirino Highway, Brgy, Novaliches, Quezon City, Metro Manila

LUKE RAMIREZ BELL CANADA SUPERVISOR IBM/CONCENTRIX +63-2-995-2426

IBM Philippines Bldg E UP-Ayala Land TechnoHub, Don Mariano Marcos Avenue, Diliman, Quezon City, Metro Manila

SUNSHINE MANAHAN WELLCARE SUPERVISOR TELEPERFORMANCE (02) 8857 3222

2/F Pavilion Greenfield District, Mandaluyong, 1552 Metro Manila

DONARD INDAC SPRINT MANAGER TELEPERFORMANCE (02) 8857 3222

2/F Pavilion Greenfield District, Mandaluyong, 1552 Metro Manila

Employment Reference/s (List of employment f or the past 7 years including self -employment and military service)
Business Start End Reason f or Supervisor Contact Number/s
Company Name Designation
Address Date Date Leaving Name (Must be active & contactable)
Level 1 & 2, Main Mall, Spark NZ Sept 2018 June 2020 Pandemic and Health RICARDO
TELETECH Robinsons Novaliches, safety AGAPITO
Quirino Highway, Brgy, 09292305237
Novaliches, Quezon
City,Philippines
IBM Metro Manila
Bldg E BELL CANADA Nov 2012 Aug 2016 Management Issues LUKE RAMIREZ
IBM/CONCENTRIX
UP-Ayala Land 09549271146
TechnoHub, Don
Mariano Marcos
Avenue, Diliman,
Quezon City, Metro
Manila
 BACKGROUND CHECK REQUEST FORM

Start Date End Date

Name of School Complete Address Course
(MM/YYYY) (MM/YYYY)
Highest Attainment

High Mother of Perpetual Help Iris Street, Dahlia Avenue, High School x Graduate
__
School
School West Fairview, 1118 Quezon
City
June 2004 March 2008
__ Senior __ Junior

#1 Esperanza St., Hilltop BS Nursing __ Graduate

Our Lady Of Fatima Mansion Subdivision, Lagro,
College university Quezon City
June 2008 2012 x Undergraduate
__
__ Vocational

Self-Declaration/ Authorization

Relative to R.A. 10173 or the Data Privacy Act of 2012, a policy that protects the fundamental human rights of privacy. I hereby
know and understand that as part of the Recruitment Process, I shall be subjected to a background investigation commissioned by
ClearSource BPO Inc. Hence, I hereby authorize the company and/or its authorized representative Right-Check Philippines to
confirm and verify my information including matters of conduct/behavior, ability/reputation, education, family, and employment as
well as my financial and credit standing. I also authorize and request each person and firm referred in my application to publish
such information.

I further certify that all information I supplied in conjunction with my application are true and correct in all aspects and I have not
willfully suppressed any fact.

Nicklaus Elliot F. Alvarez

________________________
Signature over Printed Name