Job Preference: 1. 2. 3.

How soon can you start? Referred Applicant? : Referred by: Salary Desired
Yes No
Last Name First Name Middle Name Nickname

Present Address / Telephone No. Zip Code ( ) Permanent Address / Telephone No. Zip Code ( )

Provincial Address / Telephone No. Zip Code ( ) Cellphone Number

Family Background
Name Relationship Birthdate Age/Sex Occupation Position Name of Company / Address

SAMSUNG ELECTRO-MECHANICS PHILIPPINES CORPORATION

BLK. 5 CALAMBA PREMIERE INTERNATIONAL PARK,

Spouse’s Complete Name Date of Marriage Date of Birth Latest Photo
BRGY. BATINO, CALAMBA CITY, LAGUNA
Address Occupation / Position / Company Educational Attainment
Tel. No. (049) 508-8300 / Fax. No. (049) 508-8450
Name Birthdate Age/Sex Educational Attainment

APPLICATION FOR EMPLOYMENT

Children
Personal Data

Name of School & Branch Inclusive Years Date Graduated Gen. Average Awards/Honors Received

Elementary

High School

Voc. School

College

Course

Masteral
Post Graduate
Study

Date Applied:

Employment Record (Start with the present or latest)

Inclusive date
Company Name / Address / Tel No. Position Salary Reason for Leaving
From To

Educational Background
Professional Membership / Organizations
Name of Organization Inclusive Dates Position Held

Training / Seminar Attended

Title / Topic Conducted by Inclusive Dates

Other Information / Skills

Spoken Language (in order of proficiency) Written Language (in order of proficiency)

1) 1)

2) 2)

3) 3)

Office Machines / Equipment you can operate Computer Skills

Indicate skill rating (E= Excellent, G=Good, F=Fair) MS Excel MS Access

Fax: Others (pls specify):__________________________ MS Word Database

PC __ _______________________ MS Powerpoint Others, pls. specify

Electric Typewriter

Hobbies/ Talents / Other Interests:

Were there any civil/administrative case you were involved in/ pending against you? Yes No
Details:

Government Exams / Licensure Taken

Field Date Rating License No.

Have you suffered from any serious illnesses, hospitalization or accidents in the past five (5) years? Yes No
Details:
Person to notify in case of emergency: Relation: Address & Telephone No.:

Friends / Relatives Employed at Samsung

Name Relationship Position Department Confirmation

Character references (not related to you)

 Name Company Name & Address Position Telephone / Cellphone No.

Short statements that would described your attitude as a person and as an employee

SEMPHIL as employer, process the personal information and sensitive personal information you share in course of your application. Processing includes,
but is not limited to, collection, recording, storage, updating or modification, retrieval, consolation, use, consolidation, blocking, erasure or destruction of
information. By affixing your signature below, you confirm that you have read and understood this Personal Date Consent and that you consent to
SEMPHIL collecting, processing and disclosing your personal data as written above.

I have declared true information and read the data consent in good order.

Applicant’s Signature
SSS No.
Pag-IBIG No.
TIN No.
Res. Cert No.
Issued at
Issued on

I understand that any misinterpretation or falsification, or any omission of facts of whatever nature required by this application shall be considered
sufficient cause for dismissal at any time during my employment in the Company. In addition, I am allowing or authorizing the company to check all the
information that I’ve written in this application form. If employed, I promise to undertake and abide by all the rules, regulations set and prescribe by this
company, including transfers and assignments to other locations the company deems best.