Highly Confidential

BACKGROUND SCREENING FORM

Position Applied For Date Filed (MM/DD/YYYY)

PERSONAL INFORMATION

Please provide all information in print

Last Name First Name Middle Name Suffix

Maiden Name / Other Name Date of Birth (MM/DD/YYYY) Sex Civil Status

Nationality Contact No. Best Time to Call

Email Address

ADDRESSES for the last 10 years

Number / Street / Village

Barangay State / City Province

Country Postal Code Years of Stay (MM/YYYY)

From To

Number / Street / Village

Barangay State / City Province

Country Postal Code Years of Stay (MM/YYYY)

From To

Number / Street / Village

Barangay State / City Province

Country Postal Code Years of Stay (MM/YYYY)

From To

Vanguard Screening Solutions, Inc.

VSSI-ISMS-OPS-Job Application Form v1.0 10F The Belvedere Tower, 15 San Miguel Ave
Ortigas Center, Brgy. San Antonio, Pasig City, Philippines 1605
+632 7621 7435 | Fax: +632 8857 2312 | www.vanguardscreen.com
 Highly Confidential

EDUCATIONAL BACKGROUND

List information according to your highest level attained

Name of Institution

Number / Street / Village State / City / Province Country Postal Code

Name in School Records

Educational Attainment (Post-Graduate / College / Diploma / Vocational / Senior HS / High School)

Graduated?

YES NO

If Undergraduate, kindly indicate the highest level attained and units earned:

Highest Level Attained: _________________________ Units Earned: _________________________

Dates Attended (MM/DD/YYYY)

From To

Date of Graduation (MM/DD/YYYY) (if applicable) Course of Study (if applicable)

Honors / Awards Received Student No.

Professor / Teacher’s Name Contact No. Best Time to Call

Name of Institution

Number / Street / Village State / City / Province Country Postal Code

Name in School Records

Educational Attainment (Post-Graduate / College / Diploma / Vocational / Senior HS / High School)

Dates Attended (MM/DD/YYYY)

From To

Date of Graduation (MM/DD/YYYY) Course of Study (if applicable)

Honors / Awards Received Student No.

Professor / Teacher’s Name Contact No. Best Time to Call

Vanguard Screening Solutions, Inc.

VSSI-ISMS-OPS-Job Application Form v1.0 10F The Belvedere Tower, 15 San Miguel Ave
Ortigas Center, Brgy. San Antonio, Pasig City, Philippines 1605
+632 7621 7435 | Fax: +632 8857 2312 | www.vanguardscreen.com
 Highly Confidential

PROFESSIONAL QUALIFICATIONS/MEMBERSHIPS

List information according to your most recent professional license / certification

Date of Examination /
Civil Service / R.A. 1080 Place of Examination / Date of Validity
Conferment License Number
(Board / Bar) Conferment (MM/DD/YYYY)
(MM/DD/YYYY)

EMPLOYMENT HISTORY

List information according to your most recent employer

Name of Company Contact No. Employee ID No.

Number / Street / Village State / City / Province Country Postal Code

If employed through an agency, kindly indicate the name and contact information of the agency:

Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________

Status of Employment

Regular Contractual Probationary Seasonal / On-Call

Dates of Employment (MM/DD/YYYY)

From To

Most Recent Job Title Department

Can we contact your current employer? (Kindly indicate N/A if not applicable)

Yes No If No, please indicate the date of availability: ________________________

Supervisor’s Name Contact No. Best Time to Call

Reason/s for Leaving Salary

Job Responsibilities

Vanguard Screening Solutions, Inc.

VSSI-ISMS-OPS-Job Application Form v1.0 10F The Belvedere Tower, 15 San Miguel Ave
Ortigas Center, Brgy. San Antonio, Pasig City, Philippines 1605
+632 7621 7435 | Fax: +632 8857 2312 | www.vanguardscreen.com
 Highly Confidential

Name of Company Contact No. Employee ID No.

Number / Street / Village State / City / Province Country Postal Code

If employed through an agency, kindly indicate the name and contact information of the agency:

Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________

Status of Employment

Regular Contractual Probationary Seasonal / On-Call

Dates of Employment (MM/DD/YYYY)

From To

Most Recent Job Title Department

Supervisor’s Name Contact No. Best Time to Call

Reason/s for Leaving Salary

Job Responsibilities

Name of Company Contact No. Employee ID No.

Number / Street / Village State / City / Province Country Postal Code

If employed through an agency, kindly indicate the name and contact information of the agency:

Name of Agency: _______________________ Address: _______________________ Contact No.: ____________________

Status of Employment

Regular Contractual Probationary Seasonal / On-Call

Dates of Employment (MM/DD/YYYY)

From To

Most Recent Job Title Department

Supervisor’s Name Contact No. Best Time to Call

Reason/s for Leaving Salary

Job Responsibilities

Vanguard Screening Solutions, Inc.

VSSI-ISMS-OPS-Job Application Form v1.0 10F The Belvedere Tower, 15 San Miguel Ave
Ortigas Center, Brgy. San Antonio, Pasig City, Philippines 1605
+632 7621 7435 | Fax: +632 8857 2312 | www.vanguardscreen.com
 Highly Confidential

PROFESSIONAL REFERENCES (immediate supervisors only)

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

CHARACTER/PERSONAL REFERENCES

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Name Contact No. Other Contact No. / Email Address

Employer Job Title

Relation / Affiliation Best Time to Call

Vanguard Screening Solutions, Inc.

VSSI-ISMS-OPS-Job Application Form v1.0 10F The Belvedere Tower, 15 San Miguel Ave
Ortigas Center, Brgy. San Antonio, Pasig City, Philippines 1605
+632 7621 7435 | Fax: +632 8857 2312 | www.vanguardscreen.com