FLUOR

EMPLOYMENT APPLICATION FORM
Please write legibly.

APPLICATION INFORMATION FOR HR USE ONLY
Date of Application
D t f A li ti St
Start Date
tD t
Position Applied For Position / Position Number
Cost Center / Org Unit Number
Desired Monthly Salary Employment Status
Date Available Employee Number

Gender Male Female New Hire Re‐Hire STS / Agency

PERSONAL INFORMATION
Last Name First Name Middle Name Nickname

Present Address

Permanent Address

Email Address Mobile Number Landline Number

 Birth Place Nationality

Civil / Tax Status* Spouse's Name and Birth Date Religion

Children / Dependents (use additional sheet if necessary ) Birth Date and Age Gender Relationship

1
2
3
4
Affiliations / Organizations

Professional License / Certifications (e.g. Certified Public Accountant, Registered Electrical Engineer )

IDENTIFICATION NUMBERS
SSS No. Tax Identification No.
PhilHealth No. Pag‐ibig/HDMF No.

EDUCATIONAL BACKGROUND
Honors / 
School / University Course Year Started Year Graduated
Awards
Post Graduate / PhD / MA
Bachelor's Degree
Bachelor's Degree
Vocational
Certification

Form 174‐600‐F0001 (September082014)
 EMPLOYMENT HISTORY*
*Please start with present / last employer (use additional sheet if necessary )

Employer's Name and Address From (DD‐MMM‐YYYY) To (DD‐MMM‐YYYY)

Starting Salary Final Salary

Job Title / Position
/ Reasons for leaving

Industry Type (Choose one) Employment Status
[   ] BPO  [   ] EPCM  [   ] Oil & Gas  [   ] Powe r [   ] Others ( Please specify)  ___________[   ] Regular  [   ] Probationary  [   ] Contractual  [   ] Agency

Employer's Name and Address From (DD‐MMM‐YYYY) To (DD‐MMM‐YYYY)

Starting Salary Final Salary

Job Title / Position Reasons for leaving

Industry Type (Choose one) Employment Status
[   ] BPO  [   ] EPCM  [   ] Oil & Gas  [   ] Powe r [   ] Others ( Please specify)  ___________[   ] Regular  [   ] Probationary  [   ] Contractual  [   ] Agency

Employer's Name and Address From (DD‐MMM‐YYYY) To (DD‐MMM‐YYYY)

Starting Salary Final Salary

Job Title / Position Reasons for leaving

Industry Type (Choose one) Employment Status
[   ] BPO  [   ] EPCM  [   ] Oil & Gas  [   ] Powe r [   ] Others ( Please specify)  ___________[   ] Regular  [   ] Probationary  [   ] Contractual  [   ] Agency

SKILLS / COMPETENCIES (Self‐Assessment)
Skills / Competencies Level
(e.g. AutoCAD, Microstation, SAP, Engineering software, teaching skills)

1 Beginner Average Advanced

2 Beginner Average Advanced

3 Beginner Average Advanced

ADDITIONAL INFORMATION
How did you hear about this vacancy?
Agency (Please specify)  Internet Ads (Choose one) Newspaper Ads
Career/Job Fair fluor.ph/careers Word of Mouth
Employee Referral (Please specify name) Jobstreet
Other online ads
Others
Yes No Yes No
*Have you availed of retirement benefits from  *Do you have relatives in Fluor, either by affinity 
your previous employer?
your previous employer? or consanguinity? Please specify below
or consanguinity? Please specify below.
*Are you willing to work overseas? Name Relationship
*Are you willing to accept project contractual job? 1
*Are you willing to be under agency? 2

Form 174‐600‐F0001 (September082014)
 EMERGENCY HEALTH HISTORY
Emergency Contact Details
Name and Relationship Name and Relationship

Address and Contact Number Address and Contact Number

Employer and Contact Number

Employer and Contact Number Employer and Contact Number
Employer and Contact Number

Family Doctor's Name and Address Contact Number

Hospital's Name and Address Contact Number

Answer questions carefully by placing an "×" in the boxes.
Have you ever had : Yes No Yes No
1 High blood pressure 8 Nervous breakdown
2 Any type of heart trouble 9 Asthma
3 Ulcer 10 Breathing difficulty that limited
4 Diabetes your physical capacity
5 Ruptured Hernia 11 Fainting spells, convulsions,
6 Gallstones black‐out attacks or epilepsy
7 Kindey stones
*Have you ever been awarded from any state or any branch No Yes Please specify ____________________________
of the Armed Services due to injury?

*Have you had any operations in the past?
Have you had any operations in the past? No Yes Please specify 
Please specify ____________________________

*Are you allergic to any medications? No Yes Please specify ____________________________

*Are you currently being treated to an illness or injury? No Yes Please specify ____________________________

*Do you have any physical disability? No Yes Please specify ____________________________

PLEASE READ BEFORE SIGNING

Fluor Daniel, Inc.‐Phils. (FDIP) maintains that the work environment is safer and more productive without the presence of illegal drugs and/or 
controlled substances in the workplace. FDIP, therefore, considers chemical screening as an important and mandatory pre‐employment 
requirement.
All candidates for hiring are, therefore, required to undergo a drug/chemical screening as a pre‐requisite for employment and, if already 
employed by FDIP, submit to periodic drug/chemical screening as required by the Management pursuant to Republic Act 9165 and Company 
Policy requiring random drug testing/screening. Refusal to submit to this procedure and/or results indicating use or abuse of 
prohibited/controlled substances may result in withdrawal of the job offer or, if already employed, termination of employment.
I hereby accept FDIP to contact

My present employer Yes No

All my previous employer Yes No

Are you willing to work on a shifting schedule? Yes No

I hereby grant authorization to FDIP to solicit all information and conduct background investigation in connection with this application except as
restricted above. I certify that all statements and disclosures made in this application are true and correct to the best of my knowledge and that
any misrepresentation on my part will result to the rejection of my application or, if already employed by FDIP, may be a valid ground for
termination of my employment.

Signature Date

Form 174‐600‐F0001 (September082014)
 RECOMMENDATION
Job Title Employment Status

Grade Level Cost Center Contractual

Required Start  Probationary
Salary Offer
Date
P j t
Project  Regular
Project Name
Duration
Discipline Subdiscipline STS / Agency

Org Unit 
Manager Name of agency
Hiring Offer

Relocation Allowance Php

Relocation Allowance Car Allowance
Car Allowance Php

Goodwill Bonus Php Gasoline Allowance Php

Signing Bonus Php Others

Recommended by Department Manager Checked by Human Resources

Endorsed by Engineering Manager/Project  Approved by General Manager
Operations Manager (if applicable)

Form 174‐600‐F0001 (September082014)