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Control Number: _______________

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

APPLICATION FOR EMPLOYMENT


Source : Website Walk-in Jobfair Referral :

Position Applied For : Please attach recent


ID picture
1st 2nd
Choice Choice Salary Desired : 3.5 cm x 4.5 cm
(passport size)

(Surname) (First Name) (Middle Name) Nickname

Present Address
(No.) (Street) (Village/Town) (City) (Postal Code)

Provincial Address
(No.) (Street) (Village/Town) (City) (Postal Code)

Contact Numbers
(Telephone Number) (Cellphone Number) (E-Mail Address)

Age Birthdate Birthplace Sex Height Weight


(mm/dd/yyyy)
SSS No. Pag-ibig No. TIN
GSIS No. Philhealth No. Religion
Civil Status Single Married Annulled Separated Widowed
Pls Check One Staying at own house Renting Staying with Relatives
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: From To
Position at Start Position at Leaving
Status of Appointment Leaving Salary
Job Description

Reason for Leaving

B. Company Nature of Business


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

Reason for Leaving

C. Company Nature of Business


Address / Tel. # Immediate Superior
Employment Date: From To
Position at Start Position at Leaving
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 Mark Allergies Physical Defect/Major Surgery/Illness
Blood Type Do you wear glasses / contact lenses? Yes No 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