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,28th Floor NAC Tower 32nd Street

Bonifacio Global City, Taguig City

APPLICATION FOR EMPLOYMENT

Please accomplish in your own handwriting.

Position Applying for:

Last Name

Date Applied:
First Name

Birthdate

Middle Name

Nickname

Birthplace

Age

(mm/dd/yy)

Civil Status

(Single, Married, Widow, Separated)

Citizenship

Ethnic Group

Mobile No.

Fax No.

Residence Address
Telephone No.
Provincial Address
Telephone No.

Mobile No.

E-mail address

TIN

SSS No.

HDMF No.

Philhealth No.

Sex

Height

Weight

Blood Type

Religion/Sect

Languages/Dialects spoken

Driver's License No.

Professional

Non-Professional

FAMILY BACKGROUND
Spouse (Last Name, First Name, Middle Name)

Birthdate

Occupation/Company Name

Children
Birthdate

Name

(mm/dd/yy)

Occupation/Company/School

1.
2.
3.
4.
5.
6.
Father's Name

Age

Occupation/Company

Mother's Name

Age

Occupation/Company

Siblings
Name

1.
2.
3.
4.

Birthdate
(mm/dd/yy)

Occupation/Company/School

EDUCATIONAL BACKGROUND
Year Taken

Level

From

Degree Taken

School/Address

To

Honor, Awards received

Elementary
Secondary
Vocational
Tertiary
Post Graduate
Doctorate
Licensure Examination Taken

Date Taken

Passed
Yes
No

PRC No.

1.
2.

EMPLOYMENT BACKGROUND (Latest to Previous)

1. Position held:
Employment
Date

Immediate Superior:
Brief Job Description

Company Name /
Address, Telephone Numbers

2. Position held:

Immediate Superior:

3. Position held:

Immediate Superior:

Reason of Separation

REFERENCES (Name at least 3 persons not related to you)

Name

Company / Address

Contact Numbers

Email Address

MISCELLANEOUS INFORMATION
Kind/type of Machines/equipment you can operate:
List of skills and expertise:
Are you willing to work in the minesite?

Work Overtime?

Shift work?

Who recommended you to apply to this Company? ___________________________________________ Relation:__________________

Do you have any relative or acquaintances working at the Mines? Name:___________________________Position title:_________
Have you ever been discharged or requested to resign from a company?____ If yes,pls. explain___________________________
______________________________________________________________________________________________________________________.
Have you been convicted of any crime or administrative offense?______If yes,pls. explain_________________________________
______________________________________________________________________________________________________________________.
Have you undergone a recent Physical/Medical examination?______Where:
Result:

n case of emergency, contact:

Relationship

Address

Contact Numbers

AGREEMENT AND AUTHORIZATION

I hereby assure the Company that the data I have provided on this form are complete and true. I
hereby certify that any answers to the foregoing questions are true and correct, and that I have not
knowingly withhold any fact or circumstances which would, if disclosed affect my employment
unfavorably. I fully understand that any misstatement and falsification in this form shall be a just cause
for drastic disciplinary action including dismissal.

I hereby authorize Nickel Asia Corp. and its duly authorized representative to conduct
such inquiry as may be necessary to determine my fitness from employment.
______________________________
Signature above Printed Name

_________________
Date

201 File
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Personnel Action Notice

Personnel Information Sheet, Employment Contract, JD, CV
Performance Appraisal
Awards/Citations/Certificates
Disciplinary Actions
Diploma, Transcript of Records, Medical Physical Examination Results
Pre-employment Requirements:
NBI Clearance
Brgy. Clearance
SSS- card, E-1, E-4
Philhealth- card, M1
HDMF card
BIR- TIN card, Tax Exemption, 2306

Name :
Job Title :
Company :
Department :
Date of Hiring :
Status of Employment :
CHECKLIST OF PRE-EMPLOYMENT REQUIREMENTS

College Diploma
Transcript of Records
Resignation letter or Clearance (if previously
employed)
Certificate of Employment (if previously
employed)
Photocopies of the following:
BIR Form 2316 (if previously employed)
PRC card
SSS card or E-1
TIN card
HDMF/Pag-ibig card
Philhealth card
NBI Clearance
Barangay Clearance
Birth Certificate
Marriage Certificate (if married)
Birth Certificate of child/ren (if married)