SPECS FORM: TCH-ARF-03-00

Effective: January 03, 2018

Page/s: 1 of 1

Society of Philippine Electrotechnical Constructors & Suppliers, Inc.

fs  2/F IIEE Bldg., No. 41 Monte de Piedad St., Cubao, Quezon City, Philippines 1111
: 63(02) 722-4725; ; 413-0994  : specsphils.68@gmail.com : www.specs.org.ph

AMO - REGISTRATION FORM Paste

DATE of Seminar:July 18 & 19, 2019 @ 8:00 am - 5:00 pm Recent

Venue: Quezon City Sports Club, Inc. E. Rodriguez Sr. Ave., Quezon City
2” X 2”
Table Assignment: ________________ Seat No.: ___________
(Table Assignment & Seat No to be filled – up by SPECS Secretariat) Picture
Full Name: _____________________________________________________
Last Name First Name Middle Name Suffix
Company: _______________________________________________________
Address: ___________________________________________________________________________
Tel. Nos.: __________________________________ Fax No.: ___________________________________
Cell Phone: ________________________________ Email Address: ___________________________________
PERSONAL DATA:
Age : ___________________________ Date of Birth : _______________________________
Place of Birth : ___________________________ Nationality : _______________________________
Civil Status : ___________________________ Name of Wife : _______________________________
Height : _______________________________ Weight : _______________________________
SSS No. : _______________________________ TIN No. : ________________________________
EDUCATIONAL BACKGROUND:
INCLUSIVE DATE NAME OF SCHOOL ADDRESS
Elementary : _______________ ________________________ ___________________
Secondary : _______________ ________________________ ___________________
Tertiary : _______________ ________________________ ___________________
Course : _____________________________________________________________
WORK EXPERIENCE: (Start from the most current company you have worked with backward)
COMPANY ADDRESS Date Started Date End Position

PASTE PASTE

VALID VALID

GOVERNMENT I. D. CARD - 1 GOVERNMENT I. D. CARD - 2

(PHOTOCOPY) (PHOTOCOPY)

AMO Signature 1: AMO Signature 1:

AMO Signature 2: AMO Signature 2:

AMO Signature 3: AMO Signature 3:

NOTE: DO NOT LEAVE ANY BLANK SPACE

Note: This portion is to be signed during the 1 st day of Seminar (not later than 9:00 a. m.)
[Type text]
______________________________________
Signature Over Printed Name