Certification of Employment

Background Check Form

This is to certify that Mr. RONALD MERCADO is presently employed with this College as Supervisor under Pro
Department since July 19, 2000.
Dear perty
Sir / Madame:
Our company
is presently
verifying
and work-related background of _________________________________________ who is one of
Further
certify that
his Basic
Salarytheispersonal
P 10,680.00.
our employees for regularization. This background check is a standard operating procedure of our company in order to properly evaluate the

andischaracter
of our
employee.legal
As former
Supervisor
/ Colleague
Thisqualification
certification
issued for
whatever
purpose
this may
serve. of the subject person, may we request you to fill up the form below.
Rest assured that your responses shall be treated with utmost confidentiality.

CARLO P. ROSALES
Manager for Human Resources
Date: _____________________

Issued this 1st day of August 2001.

I.

EMPLOYMENT HISTORY
Name of Company / College / Department : ______________________________________________________________
Last position held __________________________
Salary: Monthly Basic _______________________
Date of Resignation _________________________
1.
2.
3.

II.

Based on your company records and 201 file, has the subject
Employee been charged / found guilty of any offense / violation/crimes?
Has the subject been given an award, citation, commendation,
or promotion based on actual performance on the job?
Has the subject/ employee undergone APE and Drug Testing?

INTERPERSONAL RELATIONS
1.
2.
1.
4.

III.

No of Staff directly supervised _________________________

Allowances _________________________________________
Reason for Leaving __________________________________

Relationship of the subject w/ immediate superior

Relation of the subject w/ colleagues
Relation of the subject with subordinates
Relation of the subject w/ clients

WORK ATTITUDE AND CAPABILITIES

1.
2.
3.

How would you rate the work efficiency level of the subject?
How would you rate the work effectiveness of the subject?
Please rate his/her potential to handle the position :
_______________________________________

__ No
__ Yes, specify: ______________
__ No
__ Yes, specify: ________________
__ Yes, specify: ________________
Very
Poor
1
1
1
1

Poor
2
2
2
2

Fair
3
3
3
3

Good
4
4
4
4

Excellent
5
5
5
5

Very
Poor
1
1

Poor
2
2

Fair
3
3

Good
4
4

Excellent
5
5

IV

GENERAL INFORMATION
1.
What type of work does the subject like to do?
_________________________________________
2.
What are the talents and hobbies you know about the subject?
_________________________________________
3.
Any information on the strengths / weaknesses of the subject?
_________________________________________
4.
Please give an over-all assessment of the subject as a whole
in terms of his/her performance on the job?
_________________________________________
5.
Other comments / remarks?
_____________________________________________________________________

INFORMANT
NAME & SIGNATURE
RELATION WITH SUBJECT
OFFICIAL DESIGNATION
TELEPHONE NUMBER
E-MAIL
SIGNATURE

VI

: ____________________________________________
: ____________________________________________
: ____________________________________________
: ____________________________________________
: ____________________________________________
: ____________________________________________

PLEASE CONTACT US AT TEL NO: ________________________ SO THAT WE CAN ARRANGE TO PICK-UP

THIS FORM.