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( ) MOLDEX PRODUCTS, INC.
( ) MOLDEX LAND INC.
LATEST PHOTO
( ) MOLDEX REALTY INC.
( ) MOLDEX GROUP OF COMPANIES
APPLICATION FOR EMPLOYMENT
NOTE: Please fill out in block letters all blanks and check appropriate boxes.
P E R S O N A L
Family Name
First Name
Middle Name
Nickname
Date Filed:
Present Address
Tel. No.
Citizenship
Position Applied For:
Permanent Address
Tel. No.
Religion
Salary Desired:
Provincial Address
Tel. No.
Civil Status
How did you know of vacancy?
Birthdate
Place of Birth
Age
Height
Nationality
SSS No.
TIN No.
Sex
Weight
PagIbig
Name
Age
Occupation
Address
Tel. No.
If Married, Children's Name If Single, Brother's & Sister's Name
Age
Occupation
Address
Tel. No.
Spouse:
Father:
Mother:
Dependents / SSS Beneficiaries:
Name Relationship Date of Birth
_______________________________________ ___________________________________________ ________________
_______________________________________ ___________________________________________ ________________
_______________________________________ ___________________________________________ ________________
Person to be notified in case of emergency: _________________________________________________________________
Address: ____________________________________ Relationship: ___________________________________________
E D U C A T I O N A L B A C K G R O U N D
SCHOOL / ADDRESS
FROM
TO
COURSE / DEGREE (Received)
Elementary
High School
College
Post Graduate SEMINARS / TRAINING PROGRAMS AND SPECIAL COURSE TAKEN
COURSE / TITLE
NO. OF HOURS
DATES
NAME OF INSTITUTE / ADDRESS
L I C E N S U R E E X A M I N A T I O N T A K E N
EXAMINATION
DATE
LICENSE NO.
W O R K E X P E R I E N C E (List down from present to last job)
EMPLOYER'S NAME
DATE: FROM
TO
POSITION
SALARY
IMMEDIATE SUPERIOR
1
AT START:
AT START:
AT START:
ADDRESS:
UPON LEAVING:
UPON LEAVING:
UPON LEAVING:
TEL.:
REASON FOR LEAVING:
NATURE OF BUSINESS:
2
AT START:
AT START:
AT START:
ADDRESS:
UPON LEAVING:
UPON LEAVING:
UPON LEAVING:
TEL.:
REASON FOR LEAVING:
NATURE OF BUSINESS:
3
AT START:
AT START:
AT START:
ADDRESS:
UPON LEAVING:
UPON LEAVING:
UPON LEAVING:
TEL.:
REASON FOR LEAVING:
NATURE OF BUSINESS:
4
AT START:
AT START:
AT START:
ADDRESS:
UPON LEAVING:
UPON LEAVING:
UPON LEAVING:
TEL.:
REASON FOR LEAVING:
NATURE OF BUSINESS:
A F F I L I A T I O N
NAME OF ASSOCIATION / ORGANIZATION
POSITION HELD
NATURE (CIVIC, PROFESSIONAL, INTERNATIONAL, RELIGIOUS)
H E A L T H
SMOKE : _____ NONSMOKER : _____ HOBBIES & PERSONAL INTEREST: _____________________________ Date of most recent physical exam:
Result:
Nature of Past and Present Injuries:
Purpose:
Where?
Ever Hospitalized?
Do you wear eyeglasses? ____ Yes ____ No Other physical disability : _____________
List of major illness or operations you have had in the last five years.
DO YOU HAVE OR HAVE BEEN TREATED FOR ANY OF THE FOLLOWING:
1. HEART DISEASE / AILMENT YES ___ NO ___
SINCE WHEN?
2. DIABETES YES ___ NO ___
SINCE WHEN?
3. HYPERTENSION YES ___ NO ___
SINCE WHEN?
4. ANY LUNG RELATED SICKNESS YES ___ NO ___
SINCE WHEN?
5. LIVER AILMENTS YES ___ NO ___
SINCE WHEN?
6. KIDNEY DISORDERS YES ___ NO ___
SINCE WHEN?
7. NERVE DISORDERS YES ___ NO ___
SINCE WHEN?
8. OTHER AILMENTS, PLEASE SPECIFY:
O T H E R S K I L L S
____ TYPING ____ wpm ____ SWITCHBOARD OPERATION ____ OTHERS
____ SHORTHAND ____ wpm ____ CALCULATOR
____ FACSIMILE ____ COMPUTER What softwares/programs? _______________
OPERATION ____ wpm Can you drive? CAR (Yes) ____ (No) ____ How long have you been driving? __________________
TRUCK (Yes) ____ (No) ____ License No.: ________________________________
OTHERS:
M I S C E L L A N E O U S
Do you ____ own your house? ____ rent? ____ lives with parents? ____ board?
Do you gamble? ____ Never ____ Frequently ____ Occasionally
Language / Dialects (Please indicate whether fair, good or excellent):
Spoken Read Written
ENGLISH __________________ ___________________ ______________________
TAGALOG __________________ ___________________ ______________________
Others __________________ ___________________ ______________________
Do you have plans to go abroad? ____ Yes ____ No When: __________________
If you are not employed at the moment, how are you supporting your dependents, if any?
Have you ever been charged or convicted of any crime? If Yes, state the nature
C O N T A C T S
NAME(S) OF RELATIVES / FRIENDS AT MOLDEX:
RELATIONSHIP:
DEPARTMENT / POSITION:
YEARS KNOWN:
RELATIVES / FRIENDS WORKING AT ANY GOVERNMENT AGENCY:
RELATIONSHIP:
DEPARTMENT / POSITION:
YEARS KNOWN:
R E F E R E N C E S ( Other than Relatives )
NAMES
TELEPHONE:
ADDRESS:
YEARS KNOWN:
Please copy the following paragraph using your customary longhand writing:
If I am considered for the position, I agree to submit all required clearances upon the request of the Management. I promise/bind myself to accept employment under this application according to such terms and conditions as their goodselves may fix, if not contrary to law; and if employed, I promise also to obey and observe faithfully the rules and regulations and lawful orders which the authorized officers of the Corporation have issued and/or may from time to time issue. I also bind myself to report any change in my civil status or address for their proper information and guidance.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_______________________________________________________________________________________
I hereby certify that the above statements and information are true. And I bind myself that; If I get hired and employed, any misrepresentation herein shall be considered sufficient ground for my immediate dismissal for cause.
______________________________________
Applicant's Signature
dmr/hrdrev4/19/12