EMPLOYMENT HISTORY

(From the last three companies)

Name of Company: ________________________________________________________ Position: _____________________
Company Address: ________________________________________________________ Date Employed: _______________
Reason for Leaving: _____________________________________ Starting Salay/Wage: _____________________________
Name of Company: ________________________________________________________ Position: _____________________
Company Address: ________________________________________________________ Date Employed: _______________
Reason for Leaving: _____________________________________ Starting Salay/Wage: _____________________________
Name of Company: ________________________________________________________ Position: _____________________
Company Address: ________________________________________________________ Date Employed: _______________
Reason for Leaving: _____________________________________ Starting Salay/Wage: _____________________________
REFERENCES
List three (3) responsible person/s not related to you by blood or marriage who can give definite information regarding your character and ability:

NAME

ADDRESS

OCCUPATION

________________________________________
________________________________________
________________________________________
________________________________________

_________________________________________
_________________________________________
_________________________________________
_________________________________________

_________________________________
_________________________________
_________________________________
_________________________________

C E R T I F I C A T I O N
I HEREBY CERTIFY that the information above is true and correct according to the best of my knowledge and I
understand that any information found to be false shall cause this application to become null and void and in my way
obligate the Company to employ the undersigned;
Right

____________________________________________________

Res. Cert. No. ____________________

Date Issued: _____________________
Issued At: _______________________

SIGNATURE OVER PRINTED NAME

Thumb Mark

QUALIFICATIONS/EXPERIENCES:
( ) Adequate

( ) Inadequate

( ) Unrelated

( ) Satisfactory

( ) Unsatisfactory

REMARKS:

RECOMMENDATION/ S:
( ) Hire

( ) Do not Hire

( ) Hold for future Reference/s

( ) Inactive Files

Classification: _________________________________________
Assignment/Division: ___________________________________

Rate of Pay: ___________________________________

Section: _______________________________________

Location: _____________________________________________

Effective: ______________________________________

REMARKS:

RECOMMENDED FOR HIRING:

__________________________________________________
Signature

APPROVED BY:

__________________________________________________
Signature

_______________

_______________

_______________

_______________

_______________
_______________

_______________

_______________

_______________

racter and ability:

UPATION

___________________
___________________
___________________
___________________

ge and I
my way

___________________

D NAME

active Files

_______________
_______________

_______________

__________________

SUPERMIX REDI CONCRETE, INC.

167 J.P. Rizal Ave., Manggahan Rodriguez, Rizal

REMEMBER TO PROVIDE ALL THE INFORMATION REQUESTED THIS CAN HELP YOU TO GET A JOB
Date of Application: ______________________

PERSONAL DATA
Name:
(LAST)

(FIRST)

(MIDDLE)

(NICKNAME)

Position Applied for: ______________________________________________

Salary/Rate Acceptable: __________________________
Other Skills: _____________________________________________________
Religion: _______________________________________
Present Address: ______________________________________________________________________
Tel. No. _____________________
Provincial Address (if any): ______________________________________________________________
Tel. No. _____________________
SSS #: _______________________ Philhealth #: __________________________ Tin #: __________________________
Date of Birth: ____________________________ Place of Birth: ____________________________________________
( ) Male

( ) Female

( ) Single

( ) Married

( ) Widow

Height ______________ Weight _____________ Color of Eyes ________________ Hair ____________________

Father's Name: ___________________________ Address____________________________ Occupation _____________
Moher's Name: ____________________________ Address______________________________ Occupation _____________

If Married Data of Spouse:

Name:
(LAST)

(FIRST)

OTHER DEPENDENTS:
Name

(MIDDLE)
Relation

(AGE)
Birth Date

Person to be notified in case of Emergency:_____________________________________________________________

Relationship:___________________ Address: _____________________________________ Tel. Nol.: ______________
Do you or your spouse have relatives presently employed with us? ( ) YES

( ) NO

If yes, write the name and relationship: ______________________________________________________________

Have you had ( ) Tuberculosis ( ) Heart Ailment ( ) Allergies Others: _________________________________
Are you employed? ( ) YES ( ) NO

If yes, write name of employer _______________________________________

Address of employer _________________________________ Position____________________ Salary______________

Are you willing to accept re assignment/transfer to any project of the company? ( ) YES

( ) NO

List of machinery, light or heavy construction equipment you qualified to operate and rapair:
Machinery/ Equipment
Where experience/ acquired
Number of years
____________________________________
______________________________________
_______________________________
____________________________________
______________________________________
_______________________________
____________________________________
______________________________________
_______________________________
Do you posses a current Driver's License ( ) YES ( ) NO

Any other license: _______________________________

Type: ___________________ Number:______________________ Expiration Date: ____________________

Have ever been convicted of a crime? ( ) YES

( ) NO

If yes specify charge/s: ___________________________

When/where convicted: _____________________________________________________________________________

EDUCATIONAL BACKGROUND:
School Attended:

Name of School

Address of School

Graduated

Degree/s

Elementary
_____________________________
______________________________
__________________________________________
High School
_____________________________
______________________________
__________________________________________
College

_____________________________
______________________________
__________________________________________

Major Subjects: _________________________________________

Special Courses Attended:_________________________
Vocational/Trade School
Attended

O GET A JOB

_________________
(NICKNAME)

______________

_______________

_______________

_______________

_______________
_____________
( ) Separated

__________

on _____________

on _____________

(AGE)
Age

_____________

______________

___________

__________

_____________

______________

ber of years
__________________
__________________
__________________

______________

_______________

______________

Degree/s

__________________

__________________

__________________

_______________