PKIMT

PKI MANUFACTURING & TECHNOLOGY, INC.
Lot 14, Phase 1-A, First Philippine Industrial Park, Brgy. Sta. Anastacia, Sto. Tomas, Batangas
LU
FRANCIS IVAN
Surname
Birthdate
Given Name
Jun 25, 1985
Place of Birth:
Nationality:
FILIPINO
Address:
Block 11 Lot 3 South Villa Maa , Davao city
Contact No.:
Sex:
Attach
BATALLER
Middle Name
Davao City
Age:
Male
29
Blood Type:
9295567276
Passport No.:
Date of Expiry:
2" x 2" photo

with white
background
O
E-mail Address:
jovanlu08@gmail.com
Philhealth No.:
16-025588775-8
Pag-ibig No.:
(not more than 6 mon

old)
SSS No.:
n/a
n/a
TIN:
Father's Name:
Lu, Eduardo
Occupation:
n/a
Birthdate
Feb 2,
1960
Age:
Mother's Name:
Lu, Arlene Bataller
Occupation:
Accountant
Birthdate
Mar 2,
1960
Age:
Civil Status:
single
( Single, Married, Widow/er, Separated )
Spouse Name:
Occupation:
Birthdate
Age:
No. of Children:
Childs Name
Birthdate
Sex
Childs Name
Birthdate
Sex
Emergency Contact Details :

Name:
Arlene B.Lu
Contact Num. :
Have you been to Japan?
No
Name
(Yes/No)
Relationship
Relationship:
mother
If yes, indicate the no. of times and the

date(s)
( Yes/No)
Do you have immediate family in Japan?
9272447762
If yes, please enter the following details below:
Birthdate
Nationality
Place of Employment/School
Res. ID
EDUCATIONAL BACKGROUND (Starting Elementary to College)

Month/Year
Major
School / University
Month/Year
Major
School / University
June 1991
Holy Child School Of Davao
-Enrolled
June 2009
BSCE
Jose Maria College
-En
March 1997
-Graduated Nov 2013
BSCE
Jose Maria College
-Un
June 1998
-Enrolled
March 2003
-Graduated
EMPLOYMENT BACKGROUND (Please fill out the form below, start with oldest employer to the most recent)
Month/Year
Position
Company
DEC 2011
SCAA
Task Force Davao
-Employed
MARCH 2012
SCAA
Task Force Davao
-Resigned
Waiter
Monteritz Sports And Leisure Axis
-Employed
Month/Year
Position
2014
Merchandiser
Company
Activation Machine (uniliver)
-Re
-Resigned
(Other activities not mentioned on the dates above)
From
To
Activity
-Em
From
To
Activity
APR 2015
(October 2013)
PRESENT
FRONTLINE NIHONGO STUDIO DAVA
Signature over printed name
k, Brgy. Sta. Anastacia, Sto. Tomas, Batangas
Attach
2" x 2" photo
with white
background
(not more than 6 months
old)
n/a
55
55
Sex
mother
Res. ID .No.
School / University
-Enrolled
-UnderGrad
Company
-Employed
-Resigned
Activity

DE LA CRUZ
MARIA
BONIFACIO
Surname
Given Name
Birthdate
Jan 27, 1978
Place of Birth:
Nationality:
Filipino
Sex:
Address:
Middle Name
Tanauan Batangas
Age:
Male
23
Blood Type:
No.123 Labanos Street, Purok Bahay Kubo,
Contact No.:
0917-717-1111
E-mail Address:
Passport No.: XXX1234

Date of Expiry:
juandelacruz@yahoo.com
Philhealth No.:
Jan 27, 1978
12345
Pag-ibig No.:
SSS No.:
12345678
1010 0
TIN:
Father's Name:
Dela Cruz, Juanito
Occupation: Employee
Birthdate
Mar 29,
Mother's Name:
Dela Cruz,Jasmine
Occupation: Employee
Birthdate
Mar 29,
Birthdate
Dec 1,
Civil Status:
Single
Spouse Name: Dela Cruz, Ramos Devina

No. of Children:
Occupation: Housewife
5 (five)
Childs Name
Birthdate
Sex
Childs Name
Dela Cruz, Peter
Jan 1, 2008
Male
Dela Cruz, Petra
Jan 9, 2009
Female
Dela Cruz, Pasta
Feb 10, 2010
Female
Birthdate
Dela Cruz, Pepe
Mar 1,
Dela Cruz, Purisma
Jun 22,

Name:
Dela Cruz, Juanito
Contact Num. :
Yes
( Yes/No)
Do you have immediate family in Japan? Yes
Name
(Yes/No)
Relationship
Dela Cruz, Jasmine
Relationship:
If yes, indicate the no. of times and 2 times - 1st: Apr 12

2012; 2nd: Feb 14, 2013
the date(s)
Birthdate
Mother
0916-110-123456
Jan 1, 1974
Nationality
Filipino
Employer/School & Address

Hitachi Corp - Fukuoka-shi Shizuoka
Japan

Month/Year
Major
School / University
Jun 1996
--
Sky Elementary School
Mar 2000
--
Sky Elementary School Transfer
Jun 2000
--
Star Elementary School
-Enrolled
BS Marketing
Sky University
Mar 2002
--
Star Elementary School
-Graduated Apr 2010 BS Marketing
Sky University
-Enrolled
Month/Year
Major
Jun 2002
--
Sky High School
Mar 2006
--
Sky High School
Jun 2006
School / Univ
Month/Year
Position
Company
May 2011
Prod. Staf
ABC Company
-Employed Oct 2012
Store Clerk
SM Megamall
Oct 2011
Prod. Staf
ABC Company
-Resigned
Apr 2014
Store Clerk
SM Megamall
Mar 2012
Prod. Staf
ASS Factory
-Employed
Jul 2014
Warehouse Staf PKIMT Inc.
Sep 2012
Prod. Staf
ASS Factory
-Resigned
Present
Warehouse Staf PKIMT Inc.
Month/Year
Position
Compan
From
To
Activity
May 2010
May-11
Job Hunting
Nov 2011
Feb-12
XYZ Nihongo School - Basic 1 Nihongo
From
To
May 2014
Jun-14
Activity
Jobless
Signature over p
k, Brgy. Sta. Anastacia, Sto. Tomas, Batangas
1010 00011
1979 Age:
40
1979 Age:
41
1989 Age:
24
Birthdate
Sex
2011
Male
2012
Female
Father
2 times - 1st: Apr 12, 2012 to Jun 11,
2012; 2nd: Feb 14, 2013 to May 13, 2013
Employer/School & Address

Hitachi Corp - Fukuoka-shi Shizuoka
Japan
Res. ID .No.
A12345BC
School / University
Sky High School
-Enrolled
Sky High School
-Graduate
Sky University
-Enrolled
Sky University
-Graduate
Company
SM Megamall
-Employed
SM Megamall
-Resigned
PKIMT Inc.
-Employed
PKIMT Inc.
Activity
Jobless

2
Surname
Given Name
Birthdate
Nationality:
FILIPINO
Middle Name
Place of Birth:
Age:
Sex:
Blood Type:
(not m
Address:
Contact No.:
E-mail Address:
Passport No.:
Philhealth No.:
SSS No.:
Pag-ibig No.:
TIN:
Date of Expiry:
Father's Name:
Occupation:
Birthdate:
Mother's Name:
Occupation:
Birthdate:
Civil Status:
Spouse Name:
Occupation:
Birthdate:
No. of Children:
Childs Name
Birthdate
Sex
Childs Name
Birthdate

Name:
Contact Num. :
Name
If yes, indicate the no. of times and the

date(s)
( Yes/No)
(Yes/No)
Do you have immediate family in Japan?
Relationship
Relationship:
Birthdate
Nationality

Month/Year
Major
School / University
Month/Year
--
-Enrolled
--
-Graduated
--
-Enrolled
--
-Graduated
Major
School / Un
Month/Year
Position
Company
Month/Year
-Employed
Position
Compa
-Resigned

From
To
Activity
From
To
Activ
Signature ove
ark, Brgy. Sta. Anastacia, Sto. Tomas, Batangas
Attach
2" x 2" photo
with white
background
(not more than 6 months
old)
Age:
Age:
Age:
Birthdate
Sex
Res. ID .No.
School / University
-Enrolled
-Graduated
Company
Activity

PKIMT

Uploaded by

Copyright:

Available Formats

PKIMT

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

PKIMT

Uploaded by

Copyright:

Available Formats

PKI MANUFACTURING & TECHNOLOGY, INC.

Jun 25, 1985

Block 11 Lot 3 South Villa Maa , Davao city

2" x 2" photo

(not more than 6 mon

Lu, Arlene Bataller

( Single, Married, Widow/er, Separated )

Emergency Contact Details :

Have you been to Japan?

If yes, indicate the no. of times and the

Do you have immediate family in Japan?

If yes, please enter the following details below:

EDUCATIONAL BACKGROUND (Starting Elementary to College)

Holy Child School Of Davao

Jose Maria College

Holy Child School Of Davao

-Graduated Nov 2013

Jose Maria College

Holy Child School Of Davao

Holy Child School Of Davao

Task Force Davao

Task Force Davao

Monteritz Sports And Leisure Axis

FRONTLINE NIHONGO STUDIO DAVA

Signature over printed name

k, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

Signature over printed name

PKI MANUFACTURING & TECHNOLOGY, INC.

Jan 27, 1978

No.123 Labanos Street, Purok Bahay Kubo,

Passport No.: XXX1234

Dela Cruz, Juanito

( Single, Married, Widow/er, Separated )

Spouse Name: Dela Cruz, Ramos Devina

Dela Cruz, Peter

Dela Cruz, Petra

Dela Cruz, Pasta

Feb 10, 2010

Dela Cruz, Pepe

Dela Cruz, Purisma

Emergency Contact Details :

Dela Cruz, Juanito

Have you been to Japan?

Do you have immediate family in Japan? Yes

Dela Cruz, Jasmine

If yes, indicate the no. of times and 2 times - 1st: Apr 12

Employer/School & Address

EDUCATIONAL BACKGROUND (Starting Elementary to College)

Sky Elementary School

Sky Elementary School Transfer

Star Elementary School

Star Elementary School

-Graduated Apr 2010 BS Marketing

Sky High School

Sky High School

-Employed Oct 2012

Warehouse Staf PKIMT Inc.

Warehouse Staf PKIMT Inc.

(Other activities not mentioned on the dates above)