EMPLOYMENT APPLICATION FORM

Position Applied For: ______________________________________ Date: ____________________________________

Sourced thru: _____________________________________________ Desired Salary: __________________________

PERSONAL INFORMATION

LAST NAME: FIRST NAME: MIDDLE NAME:

Present Address: __ Own __ with Parents/Relatives __ Rent/Board __ Others _______________
House/Building No.: Street: Subdivision/Village:
Barangay: City/Province: Zip Code:
______check() if same with Present Address (No need to fill-out again)
Permanent Address:
__ Own __ with Parents/Relatives __ Rent/Board __ Others _______________
House/Building No.: Street: Subdivision/Village:
Barangay: City/Province: Zip Code:
Date of Birth: Birthplace: Sex:
Religion: Nationality: Height: Weight:
TIN No.: SSS No.: PhilHealth No.: Pag-ibig No.:
Telephone No.: Email Address: Cellphone No.:
Status: __ Single __ Single Parent __ Married __ Separated __ Widow
Relationship Name of Dependents Date of Birth Age Employer/School
Father
Mother
Sibling
Sibling
Sibling
Spouse
Other Source of Income: Real Estate Owned:

EDUCATIONAL BACKGROUND

School Year Graduated Degree/Course

Professional Certification/License: ____________________________________________________________________________________

Do you plan to further your education: __ No __ Yes, Course/Program/When: _____________________________________________
Languages/Dialects spoken, read, written: ______________________________________________________________________________

EMPLOYMENT HISTORY

Company Name Position Employment Dates Salary Reason for Leaving

CHARACTER REFERENCES (Provide three (3) Work References that we may contact, excluding relatives or friends):

Name Company / Position / Relationship Contact Details

REFERRALS (Provide three (3) Referrals we may contact):

Name Company / Position / Relationship Contact Details

ADDITIONAL INFORMATION
Do you have any major health
Do you have any visible tattoo? No ____ Yes ____ No ____ Yes ____
problems?
If yes, please specify: __________________________________ If yes, please specify: _____________________________________
Do you drink alcohol? No ____ Yes ____ Have you been fully vaccinated? No ____ Yes ____
If yes, how often?: _____________________________________ If yes, what brand? and when? _____________________________
Do you smoke? No ____ Yes ____ Have you taken booster shot? No ____ Yes ____
If yes, how often?: _____________________________________ If yes, what brand? and when? _____________________________

Conflict of Interest Disclosure

Do you have any past, present or pending criminal or administrative case your involved
No ____ Yes ____
with?
If yes, please specify: ______________________________________________________
Have you or any of your family members used prohibited drugs? No ____ Yes ____
If yes, please identify person and substance: ____________________________________
Do you have any other Job(s) or business(es) aside from your full-time employment with
No ____ Yes ____
the company?
If yes, please specify: _______________________________________________________
Do you have relative(s) working for a competitor? No ____ Yes ____
If yes, please specify: _______________________________________________________
Do you have relatives up to third degree of consaguinity currently employed with
No ____ Yes ____
WalterMart, Abenson or Electroworld?
If yes, please specify on the table below:

Name Company / Business Unit /Department Nature of Relationship

I hereby certify that the information furnished above are true and correct based on my own personal knowledge. I acknowledge that any false
information furnished under this interview or in the course of my application shall constitute lawful cause for the termination of my
employment with the company anytime. I agree to comply with any conditions or restrictions imposed by the company to manage conflict of
interest. Should my circumstances change in the future, I agree to submit a revised disclosure form. I hereby place my signature to certify that
the information provided in this form is complete, true
and correct to the best of my knowledge.

__________________________________________________
Signature
 AFFIDAVIT OF UNDERTAKING

I, _______________________________________, of legal age, Filipino, with address at _______________________________

_______________________________ after having been duly sworn to in accordance with law, hereby depose and state, That:

CONFIDENTIAL INFORMATION
1. I hereby acknowledge and agree that ______________________ (the company) has proprietary rights on its technology, trade secrets, and
business interests, which it has acquired over the years, and that these are considered as valuable proprietary assets. Further, I hereby
acknowledge that I obtained, access over these assets belonging to the Company, directly or indirectly, during the course of my
employment, due to a great deal of “sharing” of information, responsibility, control, training, development, accountability and recognition
between myself and the company.
2. I am under legal and moral obligation to keep secure and confidential all the information acquired in any form, written, verbal or otherwise,
having obtained access to the aforementioned valuable assets. For purpose of this undertaking, “confidential information” shall refer to all
data or information which are competitively sensitive and not known generally to the public, including but not limited to trade secrets,
business methods, clients list, price quotas, or other information which I know, or ought to have known to be confidential concerning the
business or affairs of the Company, so far as that information has come to my knowledge in the course of my employment.
3. Accordingly, I hereby undertake and promise to keep secret, and shall not at any time, whether during or after the period of my
employment, use for my own or another's advantage, or reveal to any person, firm or company, any of the said confidential information.
4. I further hereby grant my express, unconditional and voluntary consent to the Company, including but not limited to its HR, Medical, IT,
Legal, Tax, Finance and Accounting departments and personnel, to collect, store and process, whether manually or electronically my
personal information or any information or data necessary for the purposes of and in the course of my application, employment (if
accepted) or any contractual relationship with the Company, including but not limited to carrying out data analytics, management, profiling,
manual or automated decision-making and any activity related to the purposes.
5. I also grant my express, unconditional, voluntary and informed consent to, and hereby authorize, the Company, and its employees or
representatives to share, transmit or transfer my personal information to its subsidiaries and affiliates and to subcontract or outsource the
processing of my personal information to third parties acting as personal information processors on behalf of the Company (“external
service providers”) for the abovementioned Purposes, as well as authorize and grant my express, unconditional, voluntary and informed
consent to, and hereby authorize, the said entities and external service providers, if any, to collect and process my personal information for
the abovementioned Purposes.
6. I hereby knowingly and voluntarily acknowledge and confirm that I have been duly informed of my rights under the law with respect to my
personal information as well as of the Purposes of the processing, sharing, transmittal or transferring, or the subcontracting or outsourcing
of the collection and processing of my personal information. I hereby confirm that I have executed the same of my own volition and free will.

NON-COMPETE CLAUSE
7. I hereby acknowledge and agree that I shall not at anytime, whether during or after the period of my employment, either for myself or for
any other person, firm or corporation, directly or indirectly, recruit or solicit the services of any employee away from the Company, or
otherwise induce any employee to leave the Company.
8. I hereby acknowledge and agree that I shall not at any time, whether during or after the period of my employment, for any cause
whatsoever, directly or indirectly, for myself or for any person, firm or corporation, solicit, divert, take away or attempt to solicit, divert, or
take away the business or patronage of the supplies or customers of the Company in its business.
9. Upon termination of my services with the Company, I undertake to surrender to the Company all training modules and materials relating to
the business of the Company and all other materials which may contain “confidential information”. Further, I shall not be engaged or
interested, in any trade or business, which is similar to or competing with any trade or business being carried on by the Company for a period
of one year from and after my separation from the Company, unless the latter's written consent is obtained.

DRUG FREE WORKPLACE

10. I fully understand that the possession, bringing in, use, consumption, sale, purchase, or Transfer of prohibited drugs or drug paraphernalia
on or off the workplace is strictly forbidden under Republic Act No. 9165, the “Comprehensive Dangerous Drugs Act of 2002” and shall
result in disciplinary action, including termination from the service. I am fully aware that such activities can adversely affect the safety and
well-being of myself and my co-employees and the company.
11. I hereby consent to special drug searches, random drug testing, and drug testing for cause as vital measures and components of the Drug-
Free Workplace Program.
12. Moreover, I agree to abide by this Agreement on Non-Use of illegal and Prohibited Drugs and to advise the Management or Dangerous
Drugs Awareness and Enforcement Committee if I become aware of any actions or activities taken by anyone which are in violation of the
Comprehensive Dangerous Drugs Act of 2002 and the Company's pertinent policies and guidelines as embodied in its Drug Free Workplace
Program.

DAMAGES
13. I acknowledge and agree that a violation of any provision of this Affidavit of Undertaking shall make me liable for damages suffered by the
company but in no case less than Php100,000.00, in addition to any case that may be filed.

__________________________________________________
Affiant