EMPLOYMENT APPLICATION FORM

Position Applied For: Expected Salary: Date:

How did you know of our vacancy?: Friends/Relatives working in Abenson Group of companies:
Personal Information
Last Name: First Name: Middle Name:
Present Address: __ Own __ with Parents/Relatives __ Rent/Board __ Others _______________
House/Building No.: Street: Subdivision/Village:
Barangay: City/Province: Zip Code:
Permanent Address: __ Own __ with Parents/Relatives __ Rent/Board __ Others _______________
House/Building No.: Street: Subdivision/Village:
Barangay: City/Province: Zip Code:
Date of Birth: Birthplace: Sex:
Religion: Nationality: Height: Weight:
TIN No.: SSS No.: PhilHealth No.: Pag-ibig No.:
Telephone No.: Email Address: Cellphone No.:
Status: __ Single __ Single Parent __ Married __ Separated __ Widow
Name of Family Members Age Date of Birth Relationship Employer/School
Father
Mother
Sibling
Sibling
Sibling
Spouse
Children

Other Source of Income: Real Estate Owned:

Educational Background
School Year Graduated Degree/Course

Professional Certification/License: ____________________________________________________________________________________

Do you plan to further your education: __ No __ Yes, Course/Program/When: _____________________________________________
Languages/Dialects spoken, read, written: ______________________________________________________________________________
Employment History
Company Name Position Employment Dates Salary Reason for Leaving

Provide three (3) Work / Professional References who are NOT relatives or friends that we may contact:
Name Company / Position / Relationship Contact Details

Conflict of Interest Disclosure

Have you ever been involved in any case? __ No __ Yes, please specify: ___________________________________________________
Have you or any of your family members used prohibited drugs? __ No __ Yes, please specify: ________________________________
Do you have (a history of) any communicable / contagious disease? __ No __ Yes, please specify: ______________________________
Do you have any other job(s) or business(es) aside from your full-time employment with the company? __ No __ Yes, please specify:
_________________________________________________________________________________________________________________
Do you have a relative(s) working for a competitor? __ No __ Yes, please specify: ___________________________________________
rd
Do you have a relative(s) up to 3 degree of consanguinity currently employed with the Abenson Group of Companies? __ No __ Yes,
please specify:
Name Company / Business Unit /Department Nature of Relationship

I understand that false or misleading information given in my application may result to termination at any time, even after completion of
the probationary period of employment. I will also comply with any conditions or restrictions imposed by the company to manage conflict
of interest. Should my circumstances change in the future, I agree to submit a revised disclosure form.
I hereby place my signature to certify that all statements are true, correct and that no omissions were made.

__________________________________________________
Signature
REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF UNDERTAKING

I, _______________________________________, of legal age, Filipino, with address at _______________________________

_______________________________ after having been duly sworn to in accordance with law, hereby depose and state, That:

CONFIDENTIAL INFORMATION
1. I hereby acknowledge and agree that ______________________ (the company) has proprietary rights on its technology,
trade secrets, and business interests, which it has acquired over the years, and that these are considered as valuable
proprietary assets. Further, I hereby acknowledge that I obtained, access over these assets belonging to the Company,
directly or indirectly, during the course of my employment, due to a great deal of “sharing” of information, responsibility,
control, training, development, accountability and recognition between myself and the company.
2. I am under legal and moral obligation to keep secure and confidential all the information acquired in any form, written,
verbal or otherwise, having obtained access to the aforementioned valuable assets. For purpose of this undertaking,
“confidential information” shall refer to all data or information which are competitively sensitive and not known generally to
the public, including but not limited to trade secrets, business methods, clients list, price quotas, or other information which
I know, or ought to have known to be confidential concerning the business or affairs of the Company, so far as that
information has come to my knowledge in the course of my employment.
3. Accordingly, I hereby undertake and promise to keep secret, and shall not at any time, whether during or after the period of
my employment, use for my own or another's advantage, or reveal to any person, firm or company, any of the said
confidential information.

NON-COMPETE CLAUSE
4. I hereby acknowledge and agree that I shall not at anytime, whether during or after the period of my employment, either for
myself or for any other person, firm or corporation, directly or indirectly, recruit or solicit the services of any employee away
from the Company, or otherwise induce any employee to leave the Company.
5. I hereby acknowledge and agree that I shall not at any time, whether during or after the period of my employment, for any
cause whatsoever, directly or indirectly, for myself or for any person, firm or corporation, solicit, divert, take away or attempt
to solicit, divert, or take away the business or patronage of the supplies or customers of the Company in its business.
6. Upon termination of my services with the Company, I undertake to surrender to the Company all training modules and
materials relating to the business of the Company and all other materials which may contain “confidential information”.
Further, I shall not be engaged or interested, in any trade or business, which is similar to or competing with any trade or
business being carried on by the Company for a period of one year from and after my separation from the Company, unless
the latter's written consent is obtained.

DRUG FREE WORKPLACE

7. I fully understand that the possession, bringing in, use, consumption, sale, purchase, or Transfer of prohibited drugs or drug
paraphernalia on or off the workplace is strictly forbidden under Republic Act No. 9165, the “Comprehensive Dangerous
Drugs Act of 2002” and shall result in disciplinary action, including termination from the service. I am fully aware that such
activities can adversely affect the safety and well-being of myself and my co-employees and the company.
8. I hereby consent to special drug searches, random drug testing, and drug testing for cause as vital measures and components
of the Drug-Free Workplace Program.
9. Moreover, I agree to abide by this Agreement on Non-Use of illegal and Prohibited Drugs and to advise the Management or
Dangerous Drugs Awareness and Enforcement Committee if I become aware of any actions or activities taken by anyone
which are in violation of the Comprehensive Dangerous Drugs Act of 2002 and the Company's pertinent policies and
guidelines as embodied in its Drug Free Workplace Program.

DAMAGES
10. I acknowledge and agree that a violation of any provision of this Affidavit of Undertaking shall make me liable for damages
suffered by the company but in no case less than Php100,000.00, in addition to any case that may be filed.

IN WITNESS WHEREOF, I have hereunto set my hand this __________________ at Quezon City.

__________________________________________________
Affiant

SUBSCRIBED AND SWORN to before me this _________________, affiant exhibited to me his/her ______________ I.D. with
numbers _________________, as competent proof of identification in accordance with the 2004 Rules on Notarial Practice.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2014.