HUMAN RESOURCES

TALENT ACQUISITION DEPARTMENT

PRE EMPLOYMENT REQUIREMENTS CHECKLIST

Name (Last Name, First Name, Middle Name): Target Hiring Date:

Position: Functional Unit/ Department/ Unit:

REMINDERS
To facilitate your Pre-Process On-Boarding Program (P-pop) and I am St. Luke (ISL) scheduled on:___________________
You are required to complete and submit the following on or before: __________________
 Provide photocopies but bring the ORIGINAL documents for verification purposes.
 Fill out all forms. Print or type all needed information. Do not leave any blank spaces. Write N/A if the information being requested is not applicable.
 Place all documents inside a long brown envelope and write your full name (Last Name, First Name, Middle Initial) at the upper left corner
 Attach this Pre-employment Requirements checklist at the back of the brown envelope

GOVERNMENT FORMS:
SSS
Submit photocopy of any of the following documents to validate your SSS No.:
( ) SSS E-1 Form ( ) SSS Static Form ( ) SSS Verification Slip ( ) SSS Old ID (if available) ( ) SSS Website Print out of Account information
Loan Voucher Certificate or Statement of Account and Loan Payment (if applicable)
- for existing loans, voucher w/o proof of payments will not be accepted)
PhilHealth
Photocopy of Members Data Record (MDR) or Photocopy of PhilHealth ID
Pag-IBIG
Members Data Form (MDF) (print out of online registration form) or Photocopy of Pag-IBIG ID
Pag-IBIG request for Transfer of Records (if with previous employer)
Loan Voucher Certificate or Statement of Account and Loan Payment (if applicable)
BIR ( Please attach photocopy of supporting document/s for each form:)
BIR Form 1902 – Application for TIN (Applicable for no existing Tax Identification Number)
Photocopy of Tax Identification Number (TIN) Card, TIN verification slip or eTIN Verification Form
Single - birth certificate Married - marriage certificate, birth certificate of children
(Please attach "waiver of the Husband" form or sworn statement/certification of exemption if female
Solo Parent - birth certificate & birth certificate of children employee and will claim for dependent children)

OTHER DOCUMENTS:
Photocopy of Transcript of Records (if not yet available, provide photocopy of Certificate of Grades)
Photocopy of Diploma (if not yet available, provide photocopy of Certificate of Graduation)
Photocopy of Post Graduate Diploma (if applicable)
Letter of School Verification received and signed by the School's Registrar (for non-licensed position only )
Photocopy of PRC ID (front & back with your signature)
If CLAIM Stub is presented, please photocopy and indicate release date:______________)
If underage, photocopy of certificate of under age issued by PRC
Photocopy of vaid Philippine Nurses Association (PNA) Membership ID (front & back with your signature) (for registered nurse only )
Original NBI Clearance (for local employment only) If O.R. is presented, please photocopy and indicate release date: _______________
Photocopy of Birth certificate (NSO Authenticated or Certified True Copy from Local Civil Registrar’s Office)
Photocopy of Marriage Certificate (if applicable)
Photocopy of dependents’ Birth Certificate (Spouse and Children 21 y/o & below only)

BIR ( Please attach photocopy of supporting document/s for each form:)

BIR Form 2305 – Update of exemption and of Employer’s and Employee’s Information
BIR 2316 – Certificate of Compensation Payment/Tax Withheld (If last employment is within the current year)
BIR Form 1905 – Transfer from previous employer BIR RDO to BIR RDO 044-Taguig or BIR RDO 039 Quezon City
Single - birth certificate Married - marriage certificate, birth certificate of children
(Please attach "waiver of the Husband" form or sworn statement/certification of exemption if female
Solo Parent - birth certificate & birth certificate of children employee and will claim for dependent children)

Colored Pictures with white background (write your name at the back of each photo)
q 2 pieces passport size and q 2 pieces 1" x 1"
ATM Application (attach 2 pieces 1" x 1" picture and 2 photocopies of government issued ID)

I undertake to submit these requirements on the stated date above as part of my application for employment in St. Luke's medical Center.
SUBMITTED BY: RECEIVED and VERIFIED BY: REMARKS:

______________________________________ ____________________________
Applicant Talent Acquisition
(Signature over Printed Name/ Date) Signature over Printed Name/ Date
Revised 03.08.2019
 WAIVER AND ACKNOWLEDGEMENT

This is to formally acknowledge the pending medical requirements of the Associates’ Health Clinic in my Pre-
employment Physical Examination.

In light of my earnest intent however to pursue my application for employment with the St. Luke’s Medical Center,
I am hereby tendering this Waiver and Acknowledgment in the following terms:

1. I am fully aware of the nature of the position I am applying for and acknowledge the risks and dangers related
thereto considering my health condition;

2. Should the Medical Center consider my application for employment, I shall undertake and comply with all
recommendations by the Associates’ Health Clinic in one month (upon signature of this document) for the control
of my pre-existing health condition;

3. I hereby waive and hold the St. Luke’s Medical Center free and blameless from any liability ordinarily related
to my pre-existing health conditions and other complications arising from said conditions, including but is not
limited to, hospitalization, medication and other benefits. This waiver shall be effective regardless of any change of
employment status and is to be considered distinct from the normal benefits package offered by the Medical
Center to its employees of similar employment status;

4. I voluntarily agree to be separated from the St. Luke’s Medical Center should my health condition deteriorate
due to the progressive nature of my pre-existing illness;

5. As a consequence of this Waiver and Acknowledgment, I shall be personally responsible and shall bear all
necessary expenses related to the treatment and maintenance of my pre-existing health condition, which include
but is not limited to:

A. All medicines related to treatment and complications of any medical findings;

B. Confinement diagnosed as, or diagnoses related to any medical findings;

C. Diagnostic procedures related to any medical findings.

6. That in the event that the St. Luke’s Medical Center accepts my Application for Employment, I acknowledge
the same as purely an act of magnanimity and that the consideration the Medical Center have extended may be
withdrawn unilaterally.

My signature affixed below is proof that I fully understood and execute this Waiver and Acknowledgment freely
and voluntarily.

(NAME OF APPLICANT)
SIGNATURE OVER PRINTED NAME
 FPF400

REQUEST FOR TRANSFER OF MEMBER'S RECORDS

AND LOAN DETAILS (RTMRLD)

_____________________
Date
Dear Sir/Madam:
I would like to request transfer of my membership records and loan details to the _________________ with
the following information:
Name of member:
Last Name First Name Name Extensions (Jr., Sr., II, etc.) Middle Name (Maiden)

Civil Status:
Single
Legally Separated

Married
Annulled

Widow/er
Home Address:

Telephone No.:

Present Company/Employer:

Company/Employer Address:

Telephone No.: Company ID No.:

Purpose of Transfer:
Claims
Consolidation

STL o Intra-branch (within the branch )

Others, pls. Specify__________ o Inter-branch (among branches)

Check if with:

Housing Loan
STL
Takeout date : __________________ DV/Check Date : __________________
Loan Status : __________________ Loan Status : __________________
Outstanding Balance : __________________ Outstanding Balance : __________________

Name of Previous Company/Employer Company/Employer Address/Contact No. Inclusive Date(s)

1.

2.

3.

4.

Requesting Pag-IBIG Fund Branch: ______________________________

Requested by:
Processed by:

___________________________________ Noted by:

Member's Signature Over Printed Name

Revised 08/2008
To be filled up by BIR DLN:
BIR Form No.
Republika ng Pilipinas
Application for
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Registration 1902
July 2008 (ENCS)
For Individuals Earning Purely Compensation Income,
and Non-Resident Citizens / Resident Alien Employee New TIN to be issued, if applicable (To be filled up by BIR)
Fill in all applicable white spaces. Mark all appropriate boxes with an “X”.
1 Taxpayer Type Local Employee 2 Date of Registration 3 RDO Code
(To be filled up by BIR) (To be filled up by BIR)
Resident Alien Employee (MM/ DD/ YYYY)
Part I Taxpayer / Employee Information
4 TIN 5 Sex Male 6 Citizenship
(For Taxpayer w/ existing TIN)
Female
7 Taxpayer's Name 8 Date of Birth

Last Name First Name Middle Name (MM/ DD/ YYYY)

9 Local Residence Address 10 Telephone No.

No. (Include Building Name) Street Barangay/Subdivision

11 Zip Code 12 Municipality Code

District/Municipality City/Province
13 Foreign Residence Address

14 Tax Type Form Type ATC

Income Tax BIR Form 1700 - (For Individual Earning Compensation Income/Resident Alien Employee) II 011
Part II Personal Exemptions
15 Civil Status 16 Employment Status of Spouse:
Single Widow/Widower Unemployed
Legally separated Married Employed Locally
Employed Abroad
with qualified dependent child/ren without qualified dependent child/ren Engaged in Business/Practice of Profession

17 Claims for Additional Exemptions/Premium Deductions for husband and wife whose aggregate family income does not exceed P250,000 per annum
Husband claims additional exemption and any premium deduction Wife claims additional exemption and any premium deduction
18 Spouse Information (Attach Waiver of Husband)
Spouse Taxpayer Identification Number Spouse Name
18A 18B

Last Name First Name Middle Name

18C Spouse Employer's Taxpayer Identification Number 18D Spouse Employer's Name

Part III Additional Exemptions

19 Names of Qualified Dependent Child/ren (refers to a legitimate, illegitimate, or legally adopted child chiefly dependent upon & living with the taxpayer; not
more than 21 years of age, unmarried, and not gainfully employed; or regardless of age, is incapable of self-
support due to mental or physical defect).
Mark if Mentally
Last Name First Name Middle Name Date of Birth / Physically
( MM / DD / YYYY ) Incapacitated

19A 19B 19C 21D19D 19E

20A 20B 20C 21D20D 20E

21A 21B 21C 21D21D 21E

22A 22B 22C 21D22D 22E

Part IV For Employee With Two or More Employers (Multiple Employments) Within the Calendar Year
23 Type of multiple employments
Successive employments (With previous employer(s) within the calendar year)
Concurrent employments (With two or more employers at the same time within the calendar year)
[If successive, enter previous employer(s); if concurrent, enter secondary employer(s)]
Previous and Concurrent Employments During the Calendar Year
TIN Name of Employer/s

24 Declaration
I declare, under the penalties of perjury, that this form has been made in good faith, verified by me and to the best of my knowledge and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.

TAXPAYER (EMPLOYEE) / AUTHORIZED AGENT

(Signature over printed name)
Part V Employer Information
25 Type of Registered Office HEAD OFFICE BRANCH OFFICE
26 Taxpayer Identification Number 27 RDO Code
(To be filled up by BIR)
28 Employer's Name (Last Name, First Name, Middle Name, if Individual/ Registered Name, if Non-Individual)

29 Employer's Business
Address
30 Zip Code 31 Municipality Code 33 Effectivity Date 34 Date of Certification
(To be filled (Date when Exemption Information is applied) (Date of Certification of the Accuracy of the
up by the BIR) Exemption Information)
32 Telephone Number
(MM/ DD/ YYYY) (MM/ DD/ YYYY)

35 Declaration Stamp of BIR Receiving Office

I declare, under the penalties of perjury, that this form has been made in good faith, verified by and Date of Receipt
me and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the
National Internal Revenue Code, as amended, and the regulations issued under authority thereof.

Attachments Complete?
EMPLOYER / AUTHORIZED AGENT Title / Position of Signatory (To be filled up by BIR)
(Signature over printed Name) Yes No
ATTACHMENTS: (Photocopy only)
For Individuals Earning Purely Compensation Income
- Birth Certificate or any valid identification card of applicant showing complete name, address, birth date and signature (Driver's license, PRC ID or passport)
- Marriage Contract, if applcable
- Waiver of husband to claim additional exemption , if applicable
- Birth Certificate/s of dependent/s, if applicable
- Employment Certificate or valid company ID with picture and signature, if available
POSSESSION OF MORE THAN ONE TAXPAYER IDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT
TO THE PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED.
To be filled-up by BIR DLN:
BIR Form No.
Republika ng Pilipinas Certificate of Update of
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Exemption and of Employer’s
and Employee’s Information 2305July 2008 (ENCS)
Fill in all applicable spaces. Mark all appropriate boxes with an “X”.
1 Type of Filer Employee (for update of "Exemption" and other employer's and employee's information) 2 Effective Date
Self-employed (for update of "Exemption") (MM/ DD/ YYYY)
Part I Taxpayer/Employee Information
3 TIN 4 RDO Code 5 Sex
Male Female

6 Taxpayer's Name (Last Name, First Name, Middle Name) 6A Date of Birth

(MM/ DD/ YYYY)

7 Residence Address 7B Zip Code
7A

Business Address (for Self-Employed) 7D Zip Code

7C

I declare, under the penalties of perjury, that this certificate has been made in good faith, verified by me, and to the best of my knowledge and belief,
is true and correct, pursuant to the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.

8
Taxpayer/Authorized Agent Signature over Printed Name
Part II Personal Exemptions
9 Civil Status 10 Employment Status of Spouse:
Single Widow/Widower Unemployed
Legally separated Married Employed Locally
Employed Abroad
with qualified dependent child/ren without qualified dependent child/ren Engaged in Business/Practice of Profession
11 Claims for Additional Exemptions / Premium Deductions for husband and wife whose aggregate family income does not exceed P250,000.00 per annum.
Husband claims additional exemption and premium deductions Wife claims additional exemption and premium deductions
(Attach Waiver of the Husband)
12 Spouse Information
Spouse Taxpayer Identification Number
12A

Spouse Name ( if wife, indicate maiden name)

12B

Last Name First Name Middle Name

Spouse Employer's Taxpayer Identification Number Spouse Employer's Name
12C

Part III Additional Exemptions

13 Names of Qualified Dependent Child/ren (refers to a legitimate, illegitimate, or legally adopted child chiefly dependent upon & living with the taxpayer; not
more than 21 years of age, unmarried, and not gainfully employed; or regardless of age, is incapable of self-
support due to mental or physical defect).
Mark if Mentally/
Last Name First Name Middle Name Date of Birth Physically
( MM / DD / YYYY ) Incapacitated
13A 13B 13C 13D 13E

14A 14B 14C 14D 14E

15A 15B 15C 15D 15E

16A 16B 16C 16D 16E

Part IV For Employee With Two or More Employers (Multiple Employments) Within the Calendar Year
17 Type of multiple employments
Successive employments
Concurrent employments
( If successive, enter previous employer(s); if concurrent, enter main employer)
Previous and Concurrent Employments During the Calendar Year
TIN Name of Employer/s

Part V Employer Information

(If self-employed, please do not accomplish this part)
18 TIN 19 RDO Code

20 Employer's Name ( For Non-Individuals)

21 Employer's Name (For-Individuals) (Last Name, First Name, Middle Name)

Last Name First Name Middle Name

22 Registered Address

No. (Include Building Name) Street Subdivision Barangay

District/Municipality City/Province Zip Code

23 Date of Certification Stamp of Receiving Office
( MM / DD / YYYY ) and Date of Receipt
I declare, under the penalties of perjury, that this certificate has been made in good faith, verified by me and
to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal
Revenue Code, as amended, and the regulations issued under authority thereof.
24 25
Employer/Authorized Agent Signature Title/Position of Signatory
To be filled up by BIR DLN:

Republi ka ng Pilip inas Application for BIR Form No.

1905
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas Registration Information
Replac ement Copy of Certificate of Re gistration/
Re placement Copy of TIN Card/ Cessation of
Update Jan uary 2 000 (ENCS )
Re gistration/ Cancellation of TIN/ Other Update
of Registra tion Informa tion

Fill in applicable spaces. Mark all appropriate boxes with an "X".

Part I TAXPAYER INFORMATION
1 TAXPAYER IDENTIFICATION NUMBER 2 RDO Code
(TIN)
3 TAXPAYER'S NAME (Last Name, First Name, Middle Name, if individual/ Registered Name, if non-individual)

PART II REASON FOR REGISTRATION INFORMATION UPDATE

A Replacement / Cancellation of B Replacement of Lost/ Damaged G Change in Tax Type Details
Outbound Correspondence TIN Card
1 Certificate of Registration H Change in Trade Name
2 Authority to Print Receipts C Cessation of Registration
and Invoices I Update of Books of Accounts
3 Tax Clearance Certificate for D Cancellation of TIN
Transfer of Property(ies) J Change in Accounting Period
(TCL 2) / Certificate E Change in Registered Address
Authorizing Registration (CAR) K Others (Specify)
44 Tax Clearance Certificate for F Change in Registered Activities
Tax Liabilities (TCL 1)
5 Others
4 DETAILS OF REGISTRATION INFORMATION UPDATE
4A REPLACEMENT / CANCELLATION OF OUTBOUND CORRESPONDENCE
1 CERTIFICATE OF REGISTRATION
1.a Cancellation due to closure of a business 1.c Lost Certificate of Registration
1.b Correction of registration information
Nature of correction
2 AUTHORITY TO PRINT RECEIPTS AND INVOICES
2.a Change of printer as requested by the taxpayer 2.c Lost Authority To Print
2.b Correction of registration information in the Authority to Print
Nature of correction

OLD BIR PERMIT No./ OCN (To be filled up by BIR)

3 TAX CLEARANCE CERTIFICATE FOR TRANSFER OF PROPERTY(IES) (TCL 2)/CERTIFICATE AUTHORIZING REGISTRATION (CAR)
3.a Correction of information
Nature of correction

3.b Lost certificate (CAR/ TCL2)

CAR No./ OLD OCN (To be filled up by BIR)
4 TAX CLEARANCE CERTIFICATE FOR TAX LIABILITIES (TCL 1)
4.a Correction of information
Nature of correction

4.b Lost certificate

5 OTHERS (Specify)
4B REPLACEMENT OF LOST/ DAMAGED TIN CARD
Lost TIN Card Damaged TIN Card
4C CESSATION OF REGISTRATION
1 Permanent closure of business (head office) of an individual 2 Others (Specify)
EFFECTIVE DATE
OF CESSATION
4D CANCELLATION OF TIN
1 Death 5 Failure to start / commence business (For non-individual)
2 Dissolution of corporation / partnership 6 As a result of merger or consolidation
3 Permanent closure of a branch 7 Others (Specify)
4 Multiple TIN / Invalid TIN
EFFECTIVE DATE
OF CANCELLATION
4E CHANGE IN REGISTERED ADDRESS From To
1 TRANSFER OF HOME RDO

Old RDO New RDO

NEW REGISTERED
ADDRESS
ZIP CODE MUNICIPALITY CODE TELEPHONE
(To be filled up by the BIR) NUMBER
2 TRANSFER WITHIN SAME RDO
NEW REGISTERED
ADDRESS
ZIP CODE MUNICIPALITY CODE TELEPHONE
(To be filled up by the BIR) NUMBER
 BIR Form No. 1905 (ENCS) - Page 2
4F CHANGE IN REGISTERED OLD LINE OF BUSINESS NEW LINE OF BUSINESS
ACTIVITIES

EFFECTIVE DATE
OF CHANGE
4G CHANGE IN REGISTERED NAME/ TRADE NAME Registered Name Trade Name
NEW
OLD
4H CHANGE IN TAX CANCELLED TAX TYPE(S) ADDED (NEW) TAX TYPE(S) ATC
(To be filled up by BIR) (To be filled up by BIR)
TYPE DETAILS

EFFECTIVE DATE
OF CHANGE
4I UPDATE OF BOOKS OF ACCOUNTS
PSIC PSOC VOLUME NO. NO. OF
TYPE OF BOOKS TO BE REGISTERED (To be filled up by BIR) (To be filled up by BIR) QUANTITY FROM TO PAGES

4J CHANGE IN ACCOUNTING PERIOD (Applicable to non-individuals)

From Calendar Period to Fiscal Period Start Date of New Period
From Fiscal Period to Calendar Period
From One Fiscal Period to Another Fiscal Period Start Date of Old Period
4K OTHER CHANGES (Specify Details)

EFFECTIVE DATE
OF THE CHANGES
5 DECLARATION Stamp of Receiving Office
and Date of Receipt
I declare, under the penalties of perjury, that this application has been made in good faith, verified by
me, and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the
National Internal Revenue Code, as amended, and the regulations issued under authority thereof.

(To be filled up by BIR)

Taxpayer/Authorized Agent
(Signature over Printed Name)
NOTE: Attach additional sheets, if necessary
ATTACHMENTS:
A.1. Replacement of Certificate of Registration
a. Old Certificate of Registration, for replacement
b. Affidavit of Loss, if lost
c. Proof of payment of Certification Fee and
Documentary Stamp Tax - to be submitted before the issuance
of the new Certificate of Registration
2. Replacement/Cancellation of Authority to Print Receipts and Invoices
a. Original Authority to Print Receipts and Invoices
b. New Application Form 1906, if applicable
3. Replacement of Tax Clearance Certificate for Tax Liabilities
a. Affidavit of Loss, if lost
b. Proof of payment of Certification Fee and
Documentary Stamp Tax - to be submitted before the issuance
of the new Tax Clearance Certificate
B. Replacement of Lost/ Damaged TIN Card
1. Affidavit of Loss, if lost
2. Old TIN Card (if replacement is due to damaged card)
C. Cessation of Registration
1. Letter request for cessation of registration
2. Existing BIR Certificate of Registration (for surrender)
3. Inventory list of unused invoices and receipts
4. Unused invoices and receipts for cancellation
5. Same requirements as in Cancellation of TIN, if applicable
D. Cancellation of TIN
INDIVIDUAL
1. Death Certificate
2. Estate Tax Return
3. Proof of payment of existing liabilities, if any
Additional requirements for taxpayers engaged in trade or
business or exercise of Profession
4. Existing BIR Certificate of Registration (for surrender)
5. Inventory list of unused invoices and receipts
6. Unused invoices and receipts for cancellation
Attachments complete?
Yes No
Date of Release of
Title/Position of Signatory TIN
COR
Books
NON-INDIVIDUAL
1. Notice of Dissolution of Business
2. Dissolution Papers (board resolution, bankruptcy declaration)
3. Inventory list of unused invoices and receipts
4. Unused invoices and receipts for cancellation
5. Existing BIR Certificate of Registration
6. Proof of payment of existing liabilities
7. SEC issued Certificate of the Filing of the Articles of Merger/Consolidation,
if applicable
E. Change in Registered Address
1. Original Certificate of Registration
2. Inventory list of unused invoices/ receipts
3. Unused invoices and receipts for re-stamping
4. Latest DTI Certificate/ SEC Registration
5. Latest Mayor's Permit
6. Sketch of place of production (if taxpayer is subject to Excise Tax)
F. Change in Registered Activities
- Original Certificate of Registration
G. Change in Registered Name/ Trade Name
1. Amended SEC Registration/ DTI Certificate
2. Original Certificate of Registration
H. Change in Tax Type Details
- Original Certificate of Registration
I. Update of Books of Accounts
- Photocopy of the first page of the previously approved books
J. Change in Accounting Period
1. BIR written approval of the change
2. Photocopy of short period return filed
 AUTHORIZATION LETTER

THIS IS TO AUTHORIZE St. Luke’s Medical Center to obtain academic records and/or

verify the authenticity of my school documents from

___________________________________ that I have submitted, all in connection with

my employment application.

__________________________
Signature over printed name
Date: ______________________