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EMPLOYEE INFORMATION SHEET
Date:
Name:
Printed (Last) (First) (M.I.) (Nickname)
Present Address:
Telephone Number: Mobile Number: _________________________________
Permanent / Provincial Address: __
Date of Birth: / / Place of Birth:
Gender: Height: Weight:
Civil Status: ( ) Single ( ) Married ( ) Separated ( ) Widowed
EDUCATION AND TRAINING:
Dates of
Level Name of School Attendance Degree Earned
From To
Elementary
Secondary
College
Trade/ Vocational
Other out-of-school training courses taken, past or present. State where, when, length of time and under whose
auspices taken:
SKILLS, ABILITIES AND OTHER QUALIFICATIONS:
Government examinations taken. State when and for what purpose taken and rating received:
_________________________________ ______________
Languages/Dialects you can speak: ____________________________ / _________________________
Willing to work on a shifting or rotating schedule? ____________YES __________________NO
Willing to be assigned in different branches as needed? ______________ YES _____________ NO
List of business, religious, professional groups, social or civic clubs, trade associations, labor unions, church organizations,
school extra-curricular activities, past or present, in which you are a member or engaged in. Give date of membership,
position held (past or present), how much time spent, and other details:
EMPLOYMENT EXPERIENCES:
HR Department Version 1.2 Series of 2024
Daryl | [School]
Start with present or latest employment and work back to first or earliest. Use additional sheets if necessary. Give
information even though employment was part-time only or in connection with school course or with family business
only, and whether or not compensation or salary was received.
I.
Company: ____________________________________________________________________________________
Address: _____________________________________________________________________________________
Last position held: __________________________________________________________________________
Immediate Supervisor: _________
Employment Date
From: / / To: / / Salary: P
II.
Company: ____________________________________________________________________________________
Address: _____________________________________________________________________________________
Last position held: __________________________________________________________________________
Immediate Supervisor: _________
Employment Date
From: / / To: / / Salary: P
Citations, awards, medals received in the course of employment:
HOME & FAMILY
Name of Wife/ Spouse – Partner: _____________________________________________________________
Exact Address : _________________________________________________________________________________
Occupation : ___________________________________ Company : __________________________________________________________________
Number of Childen: ______________________
List of Names :
1. ______________________________________________ School: ___________________________________________
2. ______________________________________________ School: ___________________________________________
3. ______________________________________________ School: ___________________________________________
4. ______________________________________________ School: ___________________________________________
Mothers Name : ________________________________________________________________________________
Occupation : ___________________________________ Company : __________________________________________________________________
Father’s Name : ________________________________________________________________________________
Occupation : ___________________________________ Company : __________________________________________________________________
Do you: ( ) Own Home ( ) Rent ( ) Board ( ) Others:
Do you live with :( ) Own family ( ) Parents ( ) Friends ( ) Others:
PHYSICAL HEALTH:
List any physical handicaps or health problems, past or present, (high blood pressure, asthma, tuberculosis, ulcers,
rheumatism, nervous breakdown, defective eyesight, etc.) and explain their present status.
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
List illnesses or injuries you suffered in the past which required confinement in a hospital. Give date and length of
confinement, name and address of hospital, name of attending physician:
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
List illnesses or injuries you have had in the past two (2) years. From recollection, how often were you afflicted by
this/these in a year? How long has this been going on?
HR Department Version 1.2 Series of 2024
Daryl | [School]
___________________________________
When did you last consult a physician? Give date, name and address of the physician and state the consultation’s purpose
and the results which were obtained?
If you have a regular family physician, give his full name and complete address and telephone number
CHARACTER REFERENCES:
Have you been involved directly or indirectly in a court suit?
Arrested, charged or held by City, Provincial or National law-enforcement authorities for any violation of any law
regulations or ordinance? ______________________________________________________________________________________________________________
If yes, give full details.
List three (3) persons who know you very well. Do not include relatives and former employers:
Name : ________________________________________________ Years Known : ____________ Occupation : _______________________________
Company : ____________________________________________ Telephone Number : ___________________________________
Name : ________________________________________________ Years Known : ____________ Occupation : _______________________________
Company : ____________________________________________ Telephone Number : ___________________________________
Name : ________________________________________________ Years Known : ____________ Occupation : _______________________________
Company : ____________________________________________ Telephone Number : ___________________________________
Name of relatives and friends employed in <PEPA WINGS>:
FULL NAME YEARS KNOWN RELATIONSHIP/CONTACT NUMBER
Persons to be notified in case of emergency:
FULL NAME RELATIONSHIP/CONTACT NUMBER COMPLETE ADDRESS
SSS#; : _____________________________________________
TIN #: _______________________________
HDMF #: ___________________________________________
PHILHEALTH #:
EMPLOYEE LOCATOR SHEET:
Schematic location of your residence: Please sketch the most convenient way of locating your residence by indicating in
your drawing the names of streets and important landmarks along the way.
HR Department Version 1.2 Series of 2024
Daryl | [School]
NOTE: REPORT TO THE ADMINISTRATIVE OFFICE ANY CHANGE OF ADDRESS. APPLICANT’S AFFIDAVIT
I hereby certify that all information I have given in this application are true and correct. I understand and agree that this
information shall be investigated, and any falsehood, misrepresentation, or omission of facts herein will constitute
sufficient cause for my dismissal if I am already employed, regardless of the length of service I may have rendered to the
company. For this purpose, I hereby authorize PEPA WINGS to contact any of my references, former employers, and other
persons who know me or who may have information about me, and I release any and all of them from any and all
consequences or liabilities arising thereto.
_________________________________________________________________ ___________________________________________
EMPLOYEE SIGNATURE OVER PRINTED NAME FILED DATE & TIME
HR Department Version 1.2 Series of 2024
Daryl | [School]
