Application form

Personal
(Print) Last Name First Name Middle Name Nickname

MENDOZA NICOLE NELIA DILIM NICS

Present address Home Phone No.
2” X 2” ID photo

58 VILORIA ROAD, SILI, NAGUILIAN, LA UNION N/A (Please write your

Permanent address Home Phone No. complete name at the back
58 VILORIA ROAD, SILI, NAGUILIAN, LA UNION N/A of the photo before
attaching it to this form.)

Mobile phone number Citizenship E-mail address

0926 025 9621 FILIPINO nndmendoza@yahoo.com

Father’s name and age Occupation and employer

ELPIDIO B. MENDOZA; 69 YEARS OLD RETIRED ARMY

Mother’s name and age Occupation and employer

NENITA D. MENDOZA; 70 YEARS OLD RETIRED TEACHER

Spouse’s name and age Occupation and employer

N/A N/A
Person to contact in case of emergency Relation Address Contact number
58 VILORIA ROAD,
EDEL D. MENDOZA BROTHER SILI, NAGUILIAN, LA UNION, 0917 777 6823
Career
Type of application Of the following lines of services, please rank your preference with 1 being your first choice to 3 being your last.

2
____ Assurance – Financial Audit
____ Deals Advisory – Data & Analytics
____ Assurance – Internal Audit
____ Deals Advisory – Business Resiliency Services
____ Assurance – IT Audit
____ Deals Advisory – Environmental, Social, and Governance
____ Assurance – Independence and Compliance
____ Deals Advisory – Outsourcing
____ Assurance – Risk Management
____ Financial Crime (Operations)
____ Assurance – Risk Assurance (Data Analytics,
____ Advisory – Risk & Forensics Consulting
Cybersecurity & Trust and Transparency)
____ Employment ____ Advisory – Technology Consulting
1 Tax
____
____ Internship ____ Advisory – Management Consulting (Finance)
____ Tax – Worldtrade Management Services
____ Advisory – Management Consulting (Operations)
____ Scholarship ____ Client Accounting Services (Accounting, Payroll, Tax
____ Advisory – Management Consulting (HR)
Compliance)
____ Human Capital (Practice Support)
____ Deals Advisory – Strategy
____ IT (Practice Support)
____ Deals Advisory – Valuation
3 Finance (Practice Support)
____
____ Deals Advisory – Financial Due Diligence
____ Clerical/Secretarial (Practice Support)
____ Deals Advisory – Corporate Finance
____ Others
____ Deals Advisory – Capital Projects & Infrastructure
 Tertiary education
Degree/course Dates attended (mm/yy) Standing in General Honors/
School name and address
class (top weighted scholarships/
From To 10%, 25% average awards received
or lower
50%)

SAINT LOUIS UNIVERSITY

BACHELOR OF SCIENCE
2014 2020 50% N/A
IN ACCOUNTANCY

In what college activities did you participate? (academic/non-academic organizations) Dates attended (mm/yy)
Name of organization Position/s held From To
N/A N/A

Graduate and post-graduate education

Degree/course Dates attended Standing in General Honors/
School name and address
(mm/yy) graduating weighted scholarships/
class (top average awards received
From To 10%, 25%
or lower
50%)

N/A
N/A

Licensure examination/s
License/s or professional Date Rank Rating License Review school Dates attended
certificates obtained obtained number (mm/yy)
(CPA Board, Bar, CISA, From To
CIA, CFA, PMP, etc.)
N/A

Board exam review

Date of exam Rating Place / Rank

1st pre-board

2nd pre-board

3rd / final pre-board

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 General information
Approximate monthly minimum salary desired Have you applied in PwC (the firm) before? If yes, when & where?
PHP 20,000  Yes  No
Soonest date to start work Travelling restrictions Other companies applied to &
status of application
NOVEMBER 2023 NONE LANDBANK OF THE PHILIPPINES-
PENDING

Are you related to anyone in this firm or in any other accounting/consulting firm?
 Yes  No Position & nature of relationship:
How did you learn about us?
 Campus Recruitment/Job Fair  LinkedIn  Walk-In  Others
 Career Site  Jobstreet  Referred By: CARMELA ANN SANCHEZ

Reference checks
Personal (not relative) (1) Personal (not relative) (2)
Name: CARMELA ANN SANCHEZ Name: LARA GAIL GANDEZA
Position: SENIOR ASSOCIATE Position: SENIOR ASSOCIATE
Mailing address: Mailing address:
Contact number: 0975 355 3963 Contact number: 0967 568 7493
E-mail address: E-mail address:
Academic (1) Academic (2)
Name: JENNY CABANILLA Name: KENJIE AMEDA
Position: FACULTY MEMBER Position: FORMER FACULTY MEMBER
Mailing address: Mailing address:
Contact number: 0915 122 8634 Contact number:0907 492 7346
E-mail address: E-mail address: amedakenjie@gmail.com
Previous employer (1) Previous employer (2)
Name: CATHLEEN OLDICO Name: GERALDINE PERALTA
Position: ASSISTANT DEPARTMENT HEAD Position: PARISH SECRETARY
Mailing address: Mailing address:
Contact number: 0912 564 8148 Contact number: 0950 478 7868
E-mail address: E-mail address:
Warranty & waiver
In case I am not hired, I am allowing the firm to refer me to other companies for their job vacancies.

NICOLE NELIA D. MENDOZA AUGUST 29, 2023

Signature over printed name Date

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Pre-Employment Screening
Consent Form
Isla Lipana & Co., a member firm of PricewaterhouseCoopers (PwC), conducts pre-
employment screening checks of all the applicants for positions in PwC.
Please read the following carefully:
To screen your application effectively for a position, PwC will source and/or verify
information regarding some or all of the following:
• Your legal right to work in the Philippines;
• Proof of your identity and current residence;
• Educational and professional qualifications/memberships;
• Employment history and proof of activity (this involves checking how
you have been previously – for instance, checking periods of work, career
breaks etc.);
• Criminal record check which involves requesting clearance and
verification with the National Bureau of Investigation (NBI) and/or CIBI
Information Inc.)
• Credit and insolvency check.
To undertake the above checks, PwC may contact your current and previous
employers, educational and professional institutes you have attended and/or of
which you are a member, and organizations which hold criminal record information.
The results of PwC’s enquiries may contain personal data, which may include
information about your background, character and personal reputation.
The information obtained from PwC’s enquiries will be used to verify the information
presented on your application form and/or curriculum vitae and/or Pre-
Employment Screening Data Form, to assess your suitability for employment within
PwC. PwC will store the results and enquiries, as well as information provided by you,
on your personnel file and in a secure employment screening database accessible only
to selected PwC staff. PwC will store the pre-employment screening enquiries, results
and related information for no longer than is necessary for the purpose of these pre-
employment screening checks and, if appointed, your employment within PwC.
In order to carry out these screening enquiries of your background, PwC requires
your consent. By agreeing to the statement below, you will be consenting to PwC
providing data included by you on your application form and/or curriculum vitae
and/or Pre-Employment Screening Data Form to organizations and individuals who
hold personal information about you for the purpose of these organizations and
individuals verifying that information and disclosing relevant information to PwC.
Information about you will only be retained and used by PwC in accordance with
relevant data protection legislation.
For any questions relating to the personal data held by PwC in relation to this Pre-
Employment Screening Data Form, please send an email to IslaLipana@ph.pwc.com
or a letter to the following address:
Data Protection Officer
Isla Lipana & Co.
29th Floor Philamlife Tower
8767 Paseo de Roxas1226
Makati City, Philippines
Declaration & authorization
I declare that the information I have provided in connection with my application for a
position, at PwC is true and complete to the best of my knowledge. I understand that
the provision of false and misleading information may lead to the withdrawal of any
employment offer or, if appointed, to disciplinary action or termination of my
employment contract.
I also declare that I have given written consent to the references I have indicated in
my application form, curriculum vitae, Pre-Employment Screening Data Form,
and/or in any other form/document I have shared to PwC, to share my personal
information to persons and/or entities whom I seek employment, including PwC.
I further declare that I have been informed by PwC of my rights under the Data
Privacy Act of 2012, including but not limited to my right to be informed, object,
access, rectify, erase, damages, data portability and file a complaint.
I authorize PwC to undertake the pre-employment screening enquiries set out in the
Pre-Employment Screening Consent Form. Particularly, at any time once I have
signed and returned this consent form to PwC, I consent and authorize PwC to:
i. Collect, store, organize, update or modify, retrieve, consult, use and
consolidate the data, including personal information, I have shared to
and verified by PwC
ii. Perform reference checks of my employment (i.e., my past and current
employment), education, professional qualifications and background
iii. To confirm and/or verify the presence of and/or to secure a copy of my
written consent to share my personal information from the references I
have indicated in my application form, curriculum vitae, Pre-
Employment Screening Data Form, and/or in any other form/document
I have shared to PwC
iv. Share the information obtained and verified to any PwC affiliates, related
entities or other member companies
v. To provide and share the data, personal or otherwise, available to PwC,
which I have included on my application form and/or curriculum vitae
and/or Pre-Employment Screening Data Form to organizations and
individuals for the purpose of these organizations and individuals
verifying that information and disclosing relevant information to PwC
vi. Take appropriate security measures to prevent unauthorized access,
improper use or disclosure, unauthorized modification or unlawful
destruction or accidental loss of my data.
vii. Destroy the documents containing my data in any manner which PwC
thinks is best to protect the confidentiality of the information, which shall
include but not limited to destruction by fire.
I further release and forever discharge PwC, its affiliates, related entities or other
member companies, respective partners and employees, from any and all claims,
demands , damages, actions, causes of action, or suits of any kind or nature
whatsoever arising from enquiries of my credentials and background.
I understand that the information contained in and attached to my application
form/curriculum vitae and the results of the pre-employment screening enquiries
will be included in my personnel file and held confidentially on a PwC employment
screening database as long as necessary for the purpose of theses pre-employment
screening checks and, if appointed, my employment with PwC.
NICOLE NELIA D. MENDOZA
________________________________________________
Printed Name with Signature
Date
AUGUST 29, 2023
Date of Birth JULY 15, 1998
Please also list any other names by which you are currently/ have previously been
known (e.g. maiden name).
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