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Authorization For Background Check: Pang-Alaalang Sentrong Medikal Quirino
Authorization For Background Check: Pang-Alaalang Sentrong Medikal Quirino
Authorization For Background Check: Pang-Alaalang Sentrong Medikal Quirino
Kagawaran ng Kalusugan
PANG-ALAALANG SENTRONG MEDIKAL QUIRINO
(QUIRINO MEMORIAL MEDICAL CENTER)
JP Rizal cor. P. Tuazon Blvd cor Katipunan Road, Project 4, Quezon City, Philippines, 1109
Website : www.doh.gov.ph/qmmc Email add: qmmc_doh@yahoo.com
Trunkline Nos: 5304-9800
(Please read and sign this form in the space provided below. Your written
authorization is necessary for completion of the application process)
I hereby release all persons or entities requesting or supplying such information from
any liability arising such disclosure. I confirm and acknowledge that a photocopy or
scanned through e-mail of this authorization be accepted with the same authority as
original.
I acknowledge that I have read and hereby agree to the collection, use, processing
and transfer of any data about me in accordance with the RA No. 10173 also known
as Data Privacy Act of 2012.
I also understand that I may withhold my permission and that in such case, no
background checking will be done, and my application for employment at the Quirino
Memorial Medical Center will not be processed further.
Signature:
Printed Name:
Date:
Issued ID:
CENTER OF EXCELLENCE