Personal Background Form

Paste a recent 1x1 ID picture with your printed name at the back. APPLICATION FOR EMPLOYMENT Please type or print all entries clearly. Do not leave blanks. Indicate N/A if not applicable. Attach: resumé, photocopy of transcript/grades, photocopy of proof of eligibility/PRC license/Bar rating, ID picture

Respondent to: Walk-in Referral by DBP Employee Nickname: Email Name: Expected Salary: Others: Dept/Br: Local: (do not leave blank)

Preferred Assignment: 1st 2nd 3rd (specify Head Office Dept or Branch) choice: choice: choice:

PERSONAL DATA Last Name First Name Middle Name Maiden Name (if married)

Age Date of Birth (MM-DD-YY) Place of Birth Citizenship Civil Status Religion Sex

Present Address Telephone/Fax

Provincial Address Telephone/Fax

Email Address Mobile/Cellphone

EDUCATIONAL BACKGROUND Course / Degree / Major Level Name of School / Address Year Graduated Honors / Awards (if undergraduate, indicate number of units)

Post-Graduate

College

High School

Elementary

Others

GOVERNMENT AND PROFESSIONAL EXAMINATION/S PASSED Title of Examination Date of Examination (MM-DD-YY) Place of Examination Rating

EMPLOYMENT RECORD (Start from most recent. Indicate history of employment since 16th birthday. Use additional sheets if necessary.) Inclusive Dates (MM-DD-YY) Status of Gross Monthly Reason for Position Employer / Location From To Employment Salary Leaving

SEMINARS / TRAINING PROGRAMS ATTENDED (Start from most recent. Use additional sheets if necessary.) Inclusive Dates (MM-DD-YY) Number of Title of Course Venue Organized/Sponsored by From To Hours

FAMILY BACKGROUND (Use additional sheets if necessary.) Name of Spouse (if married) Age Address of Spouse

of 2 PAP 00312 (Rev 0 – 17May12) Date of Marriage (MM-DD-YY) Place of Marriage Occupation of Spouse Spouse’s Employer/Address

Name of Parents and In-Laws Age Address Occupation/Employer

Father

Mother

Father- in-Law

Mother- in-Law Name of Dependents Age Relationship Date of Birth

Name of Brothers and Sisters Age Occupation/Employer Civil Status

RESIDENCE OF MORE THAN SIX (6) MONTHS DURATION FROM 15TH BIRTHDAY Inclusive Dates (MM-DD-YY) Complete Address From To

ADDITIONAL INFORMATION (Please mark your responses. Use additional sheets if necessary.) 1. Have you ever been retired under any retirement law? If yes, please give details: YES NO

2. Have you ever been found guilty or been penalized for any offense or violation involving moral turpitude or carrying the penalty of disqualification to hold public office? If yes, please check nature of offense, and specify name of court or administrative board and disposition of case: YES NO Administrative Provide Civil details: Criminal 3. Have you ever been suspended, discharged or forced to resign from any of your previous positions? If yes, provide details: YES NO

4. Do you have a credit card or 1. YES NO an existing loan? If yes, give 2. details: 3. 5. Have you taken the DBP pre-employment test at the Head Office or any Branch Office before? If yes, provide details: YES NO Date: Venue: Status: YES NO 6. Are you willing to accept contractual employment? 7. Do you have any relative within the fourth degree of consanguinity or affinity working in DBP? If yes, provide details:

Name/s of YES NO Relationship: Relative/s:

REFERENCES (Do not include relatives.) Name Occupation Address Contact Details (Cellphone/Email)

I hereby certify that the statements made by me are true, complete, accurate, and correct to the best of my knowledge and belief. Any false information contained herein may serve as grounds for cancellation of my Applicant’s Signature over Printed Name application or dismissal in case I am employed. This likewise serves as an authorization to conduct investigation on my personal background. Date Accomplished

of 2 PAP 00312 (Rev 0 – 17May12)