Control Number:

DEPARTMENT OF ENERGY
Energy Center, Rizal Drive, Bonifacio Global City
1632 Taguig City, Philippines

APPLICATION FOR EMPLOYMENT

Source : X Website Walk-in Jobfair Referral :

Position Applied For : Please attach recent

Administrative Administrative ID picture
1st 2nd
3.5 cm x 4.5 cm
Choic Officer I Choi Officer III Salary 33,000 (passport size)
e ce Desired :

Salamera Jesus Antonio III Llave Anthony

(Surname) (First Name) (Middle Name) Nickname
1004
Present 2078 E Smith St. San Andres Malate, Manila
Address
(No.) (Street) (Village/Town) (City) (Postal Code)

Provincial Address 2078 E Smith St. San Andres Malate, Manila 1004
(No.) (Street) (Village/Town) (City) (Postal Code)

Contact Numbers 85218118 09454835427 [email protected]

(Telephone Number) (Cellphone (E-Mail Address)
Number)
MANIL
Age 23 Birthdate May 09, 2001 Birthplace Sex MALE Height 6’ Weight 80kg
A
(mm/dd/yyyy)
SSS No. Pag-ibig No. TIN
GSIS No. Philhealth No. Religion Roman Catholic

Civil Status X Single Married Annulled Separated Widowed

Pls Check Staying at own house Renting Staying with Relatives
One
Languages / Dialects Spoken
Interests / Hobbies / Past time
Other Special Skills / Can operate or use (machines/eqpt/software)
Other special qualifications, books published, article written
Are you willing to be assigned in the province? Yes No If yes, indicate what preferred location

EDUCATION
Name & Address of School Attended Course / Degree / Major Inclusive Date of Attendance Honors/Distinction
Received
Elementary
Secondary
Vocational
College
Post Graduate
Study / Scholarship Grant

EMPLOYMENT HISTORY
(Start with your present or latest job)

A. Company Nature of Business

Address / Tel. Immediate Superior
#
Employment Date: To
From
Position at Position at Leaving
Start
Status of Appointment Leaving Salary
Job Description

Reason for Leaving

B. Company Nature of Business

Address / Tel. Immediate Superior
#
Employment Date: To
From
Position at Position at Leaving
Start
Status of Appointment Leaving Salary
Job Description

Reason for Leaving

C. Company Nature of Business

Address / Tel. Immediate Superior
#
Employment Date: To
From
Position at Position at Leaving
Start
Status of Appointment Leaving Salary
Job Description

Reason for Leaving

If you need extra space to complete this form, use a separate sheet of paper.
Application Form . P2
TRAINING AND SEMINAR
Training and Seminar Attended Inclusive Period No. of Training Hours Conducted by

CIVIL SERVICE ELIGIBILITY (INCLUDING BAR OR BOARD EXAMINATION)

Examination Place Date Rating

FAMILY DATA
(Parents, Spouse, Children, Brothers and Sisters) Please put an "+" in the "age" column if family member is deceased.
BIRTH DATE PROFESSION /
FULL NAME AGE RELATION WHERE EMPLOYED
mm/dd/yyyy OCCUPATION
1
2
3
4
5
6
7
8
9
10
MEDICAL HISTORY
Birth Allergies Physical Defect/Major Surgery/Illness
Mark
Blood Do you wear glasses / contact lenses? Yes No
Type Grade
CHARACTER REFERENCES
Give at least three (3)

Name Position Company/Address Contact Number

Please List down all relatives by consanguinity or affinity to any official or employees of the Department of Energy or any attached
agency.
Name of Relative(s) Relation Company Occupation/Position

Have you ever been accused of indicted/tried for the violation of any law, ordinance or regulations before any court or tribunal, or
have you ever been accused/charged, or tried for any breach of infraction of military, naval or constabulary discipline in an
administrative action?
Yes No (If yes, give the date and state the nature of offense and penalty)

Have you ever been previously retired or were you given separation pay?
Yes No (If yes, please indicate amount )

In case of emergency, who should we notify? Name Relation

Address: Phone No.

ALL INFORMATION I HAVE SUPPLIED IN THIS APPLICATION ARE TO THE BEST OF MY KNOWLEDGE, TRUE AND CORRECT.
I UNDERSTAND THAT THIS AUTHORIZES THE MANAGEMENT OF THE DEPARTMENT OF ENERGY TO CONDUCT
BACKGROUND CHECK / VERIFICATION RELATIVE TO THIS APPLICATION. I UNDERSTAND FURTHER THAT ANY
DELIBERATELY UNTRUE INFORMATION OR FALSE STATEMENT GIVEN HERE WILL BE SUFFICIENT CAUSE OF
DISQUALIFICATION OF MY APPLICATION AND CAN BECOME A BASIS FOR MY DISMISSAL (IF AND WHEN HIRED).

Printed Name and Signature Date

Rev No/ Rev Date: 2 / July 8, 2016