Jessa M.

Villacorta
B.A. Psychology - IV

MIDTERM/ SEMI-FINALS

Psychological Interview

(PSY 27)

Permit #.

INTERVIEW SCHEDULE

 Educational Setting

 Counseling Setting

 Industrial Setting

 Hiring

 Grievances with Employees

 Mini Research
EDUCATIONAL SETTING: Pre-school and Elementary

Note: the parents or guardian of the student are asked to fill this form.

VILLACORTA SPECIAL SCHOOL SYSTEM, INC.

-oOo-

STUDENT’S INFORMATION SHEET

NAME: _____________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME

ADDRESS: _______________________________________ TEL. NO. _________________________

DATE OF BIRTH: __________________ SEX: _______ PLACE OF BIRTH: __________________

NAME OF PARENTS:

FATHER: __________________________________________ OCCUPATION: _________________

BUSINESS ADDRESS: ____________________________________ TEL. NO. __________________

MOTHER: _________________________________________ OCCUPATION: _________________

BUSINESS ADDRESS: ____________________________________ TEL. NO. __________________

 EDUCATIONAL SETTING: Secondary

VILLACORTA SCIENCE HIGH SCHOOL

-oOo-

STUDENT’S INFORMATION SHEET

Year: __________________ Section: _______________

Date: __________________

Name__________________________________________
(Last) (First) (Middle)

Sex_________________ Nationality__________________ Religion__________________

Date of Birth ___________________________ Place of Birth________________________
Home Address _________________________________ Telephone No. ______________
_________________________________ Mobile No. ________________
_________________________________
Elementary School Graduated From _____________________________Sch. Yr. _______
Address of School/Location _____________________________________
_____________________________________
Father’s Name ________________ Age ___________ Birthplace ____________________
Education _______________ Occupation ______________ Place of Work_____________
Living ( ) Dead ( ) Cause of Death _____________________________________
Living with the Family ( ) Yes ( ) No Abroad ( ) Separated ( )
Mother’s Name ________________ Age ___________ Birthplace ___________________
Education _______________ Occupation ______________ Place of Work _____________
Living ( ) Dead ( ) Cause of Death ____________________________________
Living with the Family ( ) Yes ( ) No ( ) Abroad ( ) Separated
No. of Children in the Family: Brothers ___________ Sisters _________
Stepbrothers _______ Stepsisters _________
Housing condition ( ) Owned ( ) Shared with grandparents or relatives
( ) Rented ( ) Rent to Own
Subject Liked Best _________________________ Subject Liked Least _______________
Hobbies ______________________________________________________________________
Special Talents ________________________________________________________________
Clubs/Organizations Joined ___________________________________________________
Ambition _____________________________________________________________________
Course you intend to take after high school ____________________________________
In case of emergency please contact: _____________________
Relation: _____________
Address: _____________________
Mobile No. ___________________
 EDUCATIONAL SETTING: Tertiary

VILLACORTA UNIVERSITY

-oOo-

STUDENT’S INFORMATION SHEET

PERSONAL DATA

NAME: ___________________________________________ AGE:_________ SEX:_______

LAST NAME FIRST NAME MIDDLE NAME

ADDRESS: _______________________________________ TEL. NO. ___________________

DATE OF BIRTH: __________________ PLACE OF BIRTH: _____________

CIVIL STATUS: __________ NATIONALITY

FATHER’S NAME ____________ AGE ___________ BIRTHPLACE ____________________

EDUCATION ___________ OCCUPATION ___________ PLACE OF WORK_____________
MOTHER’S NAME _____________ AGE ___________ BIRTHPLACE ___________________
EDUCATION __________OCCUPATION ___________ PLACE OF WORK _____________

CHECK WHICH APPLIES TO YOU:

______ NEW STUDENT
______ OLD STUDENT
______ TRANSFEREE
______ SHIFTER

UNITS EARNED: __________________

 COUNSELING SETTING: for counseling information it would be best to have a

highly scheduled fill up form to gather essential data about the counselee these

may provide a to background review for the counselor before proceeding with a

non-scheduled interview.

HIGHLY SCHEDULED

VILLACORTA UNIVERSITY

Guidance Center

Calasiao, Pangasinan

-oOo-

COUNSELEE’S INFORMATION SHEET

Purpose: to draw together all essential information about you that might help in your

counseling session. If some questions are misunderstood feel free to ask your counselor

for clarifications. All information would be kept confidential

PERSONAL DATA

Name__________________________________________ Nickname _________________

(Last) (First) (Middle)
Sex_________________ Nationality__________________ Religion__________________
Date of Birth ___________________________ Place of Birth________________________
Home Address _________________________________ Telephone No. ______________
_________________________________ Mobile No. ________________
________________________________ Civil Status _________________
FAMILY BACKGROUND
Father’s Name ________________ Age ___________ Birthplace ____________________
Education _______________ Occupation ______________ Place of Work_____________
Living ( ) Dead ( ) Cause of Death _____________________________________
Living with the Family ( ) Yes ( ) No Abroad ( ) Separated ( )
Mother’s Name ________________ Age ___________ Birthplace ___________________
Education _______________ Occupation ______________ Place of Work _____________
Living ( ) Dead ( ) Cause of Death ____________________________________
Living with the Family ( ) Yes ( ) No ( ) Abroad ( ) Separated
No. of Children in the Family: Brothers ________ Sisters _________
Stepbrothers _____ Stepsisters ______
Housing condition ( ) Owned ( ) Shared with grandparents or relatives
( ) Rented ( ) Rent to Own

Only answer this portion if married.

Name of Spouse________________ Age ___________ Birthplace ___________________
Education _______________ Occupation ______________ Place of Work ____________
Living ( ) Dead ( ) Cause of Death ____________________________________
Living with the Family ( ) Yes ( ) No ( ) Abroad ( ) Separated
No. of Children _________________ Boys _____________ Girls_______________

FAMILY INCOME
Note: Encircle one that applies to you
a. P 5, 000 and below
b. P 5, 001 – P 10,000
c. P 10,001 – P 15,000
d. P 15, 001 – P 20, 000
e. P 20, 000 – above
EDUCATIONAL BACKGROUND

NAME OF SCHOOL YEAR GRADUATED

Elementary _________________________ ______________________
Secondary __________________________ ______________________
Tertiary ____________________________ ______________________
Course: _____________________________
Subject Liked Best _________________________ Subject Liked Least _______________
Hobbies __________________________________________________________________
Special Talents ____________________________________________________________
Clubs/Organizations Joined __________________________________________________
Achievements ________________________________________________________________
_________________________________________________________________
_________________________________________________________________

NON - SCHEDULED

CASE: The counselee (female) was forced by his boyfriend to have sex with him. The

counselee now feels guilt and is bothered by the act she had committed with him. Soon

she found out that she was pregnant and is now scared of her parents finding out.

Counselor: So tell me ________________ what is bothering you?

Counselee: I- uh.. uhm…

(counselor notices the counselee being hesitant and waits for the counselee to find her

words, after a while the counselee, eases.)

Counselee: I have been really bothered for the past few weeks. It all started when my

boyfriend forced me to have sex with him. I really love him and so I agreed even though
I wasn’t sure, but then when we were about to do it I changed my mind I knew I wasn’t

ready yet. Then he forced himself into me. . .(looks away)

Counselor: uh-huh

Counselee: He was sorry afterwards and so I forgave him. Ever since that, I have been

feeling . . . guilty. I came from a pious family I wanted to do it after I get married. I

sometimes console myself by saying I’d only want to do it with him anyway so it wouldn’t

make any difference. .But I really feel guilty and impure now. We didn’t do it with any

protection. . .

(Counselee starts crying, counselor hands a tissue box for her)

Counselee: After a few weeks. I started feeling nauseous and so my boyfriend and I

bought a pregnancy test to check if I am pregnant. And it turns out that I am. I’m scared

to have an abortion, knowing that I’ll be even more bothered by guilt if I do it. I don’t

know how to tell my parents. I’m scared to tell them. I am so ashamed.

Counselor: my dear, you have been feeling guilt since you are a good person and you

aren’t comfortable that you did something wrong. Don’t think that you are impure. Being

pregnant while still studying is a hard situation. It is good that you have all intention to

tell your parents. It’s just that you are scared to tell them how.

Counselee: I am so scared I really don’t know what to do I’ve been really stressed about

it.

Counselor: Don't be too hard on yourself about it it'll only stress you out and

make the situation worse. If you're pregnant, you do know that hiding it isn't

going to do anything but make it worse and make them more mad. Your best
option is to tell you parents. With your mom, I would talk to her really calmly

and just tell her mom I made a mistake and I'm pregnant. I really need your

support to get through this. If she freaks out, give her time to cool down

because it's probably going to be a big shock to her. Same thing with your dad.

Eventually they are going to have to get used to it, accept it, and move forward

with what it is. You'll just have to take it step by step.

Counselee: I’ll really try to talk to them. I don’t know what will happen to me in

the future. People will be talking about me.

Counselor: people will talk even if you’re pregnant or not. What is important is

that you get the support system you need. Your life would not end if you get

pregnant early. For now, you would also need the help of your boyfriend’s

family. So both of you should tell them your situation. You can also make him

come with you for our session after lunch. So that I can talk to you both on

what steps to take.

Counselee: I’ll make him come with me later.

INDUSTRIAL SETTING: HIRING

* Usually an applicant form is provided (highly scheduled) followed by a short

interview (non-scheduled).

HIGHLY SCHEDULED

Villacorta Galleria

Application Form

Insert photo here

Walk-in _______

Job Fair _______

PERSONAL INFORMATION DATE OF

APPLICATION:______________

Name:

___________________________________________________________________________

Last First Middle

Date of Birth: __________ Place of Birth___________Age: ___________ Sex: ________

Civil Status: _____________ Nationality ________________ Religion ______________

Address: ____________________________________________________________________

Alternate Address: __________________________________________________________

Home Telephone:________Mobile Telephone _____________ Email ______________

If married please fill the portion below:

Name of spouse: _________________________ Age: ______ Birthdate: ______________

Date of Marriage_____________ Living, Deceased, Separated: __________________

Number of Children: ______________ Contact number: ________________________

POSITION SOUGHT : _________________________ Available Start Date:__________

Desired Pay Range: ________________ Are you currently employed? _________

Hourly or Salary

EDUCATION

Year
Name and Location Course/ Major
graduated

High School

College or

University

Specialise training,

Trade School, etc

Other Education/

Graduate

Please list your areas of highest proficiency, special skills or other items that

may contribute to your abilities in performing the above mentioned position.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

PREVIOUS EXPERIENCE

Please list beginning from most recent

Dates Employed Company Name Location Role/Title

_______________ ________________________ _________________

_______________

_______________ __________________________ _________________

_______________

_______________ __________________________ _________________

_______________

_______________ ___________________________ _________________

______________

Person’s to contact for verification:

Name of Employer ________________ Contact number: _________________________

Name of Employer ________________ Contact number: _________________________

Name of Employer _________________ Contact number: _________________________

Name of Employer ________________ Contact number: _________________________

NON - SCHEDULED

*If a client has no work experience

HR: so you’re a fresh graduate why do you want to work in our company?

*if a client had several work experiences

HR: what made you leave your previous work?

INDUSTRIAL SETTING: GRIEVANCES

Villacorta Galleria

Employee Grievance Form

Grievant Information

Employee Name: __________________________________________________ Date:

___________________________

Job Title: ___________________________ Employee ID: ________________________

Date of Hire: _______________

Home Mailing Address: ____________________________________________________

Work Mailing Address: _____________________________________________________

Date, time and place of event leading to grievance:

______________________________________________________________________________

_____________________________________________________________________________

Detailed account of occurrence (include names of persons involved, if any):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please state policies, procedures, or guidelines that you feel have been violated:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Proposed solution to grievance:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

The grievant should retain a copy of this form for his/her records. The signature

below indicates that you are a filing a grievance, and any information on this

form is truthful.

_______________________________________________ ____________________

Employee Signature Date

________________________________________________ _____________________
Received by Date
NON – SCHEDULED

An (male) employee filed a grievance form against his co-employee who has been

the thief roaming around their office rummaging in each cubicle. A CCTV was

planted in the office and may provide evidence for the other stealing event that

has happened there. His Samsung Galaxy Note was stolen on 3/6/14 during

lunch. The janitress Mrs. Kita saw Mr. Dukot leave his cubicle around 12:40 pm.

He wants Mr. Pavaya to be fired and to return his gadget.

HR: so Mr. Pavaya, this complaint is really desctructive for Mr. Dukot. Once the

CCTV does prove that he did stole your Samsung…… then he can technically get

fired for being harmful in the office since you did say that you weren’t the only

victim of thievery here.

Mr. Pavaya: indeed other employees are willing to file as well for his removal in

this company.

HR: Well then, we’ll have to first look at the CCTV footage of what happened that

time in your office. Then we’ll call on you to come for the results.