Position Applied for Date filed (MM/DD/YYYY)
PERSONAL DETAILS
List all information in print
Last name (in all CAPS) First name Middle name
Other names (AKA Name) Date of Birth Marital Status
(MM/DD/YYYY)
Date of Marriage Place of Marriage State/City/Province Country
Nationality Gender Personal email address Official email address
National ID no. or Passport no. Country of issue Expiration date
Telephone no. Mobile no. Other no.
PRESENT ADDRESS
Number/Street/Village State/City/Province
Country Postal code
PERMANENT ADDRESS
Number/Street/Village State/City/Province
Country Postal code
PREVIOUS ADDRESSES For the last 10 YEARS
Number/Street/Village State/City/Province Country Postal code Years of stay
From MM/YYYY to
MM/YYYY
Mother's maiden name Father's full name
Spouse' full name
Siblings Birthdate If Employed If studying
Occupation Company Year/Course School
EDUCATION INFORMATION
List information starting from the highest degree obtained
Name of Institution
Address State/City/Province Country Postal code
Dates attended (MM/DD/YYYY)
From To
Degree obtained Major
Graduated? □ YES □ NO GPA
Date of graduation (MM/DD/YYYY) Enrollment #
Name of Institution
Address State/City/Province Country Postal code
Dates attended (MM/DD/YYYY)
From To
Degree obtained Major
Graduated? □ YES □ NO GPA
Date of graduation (MM/DD/YYYY) Enrollment #
PROFESSIONAL LICENSES/ CERTIFICATION/ MEMBERSHIP
List information of professional membership starting from the most recent membership
Name of institution Date joined Type of membership Membership status
(MM/DD/YYYY)
EMPLOYMENT INFORMATION
List information starting from the most recent employer
Name of company Contact number Employee ID
Address State/City/Province Country Postal code
Status of employment Supervisor name Supervisor contact number
□ Permanent □ Contractual □ Probationary
Dates of employment (MM/DD/YYYY)
From To
Can we contact your current employer? □ Yes □ No If No, please provide the date:
Job title Department
Job responsibilities
Reason for leaving Last Salary
Name of company Contact number Employee ID
Address State/City/Province Country Postal code
Status of employment Supervisor name Supervisor contact number
□ Permanent □ Contractual □ Probationary
Dates of employment (MM/DD/YYYY)
From To
Job title Department
Job responsibilities
Reason for leaving Last Salary
Name of company Contact number Employee ID
Address State/City/Province Country Postal code
Status of employment Supervisor name Supervisor contact number
□ Permanent □ Contractual □ Probationary
Dates of employment (MM/DD/YYYY)
From To
Job title Department
Job responsibilities
Reason for leaving Last Salary
Name of company Contact number Employee ID
Address State/City/Province Country Postal code
Status of employment Supervisor name Supervisor contact number
□ Permanent □ Contractual □ Probationary
Dates of employment (MM/DD/YYYY)
From To
Job title Department
Job responsibilities
Reason for leaving Last Salary
PERSONAL REFERENCES
Name Mobile Number Other Contact Number
Company/ Organization
Position/ Title Relation/ Affiliation
Name Mobile Number Other Contact Number
Company/ Organization
Position/ Title Relation/ Affiliation
Name Mobile Number Other Contact Number
Company/ Organization
Position/ Title Relation/ Affiliation
ADDITIONAL Information
1. Have you ever been arrested or convicted of any criminal offense? Yes No If yes, please provide details
Isthe case still pending? Yes No
2. Have you ever been declared bankrupt or had a petition of bankruptcy? Yes No If yes, please provide details
3. Have you ever been involved in any civil judgments, as a Plaintiff or Defendant? Yes No If yes, please provide
details
4. Have you ever been refused entry to any country? Yes No If yes, please provide details
5. Have you ever been terminated or dismissed by any employer? Yes No If yes, please provide details
6. Have you ever been involved in any act of violence? Yes No If yes, please provide details
7. Are you currently engaged in any other business either as a proprietor,
partner, director, trustee, and employee or otherwise?
Yes No
If yes, please provide detail
Declaration
I hereby certify that all information provided in this form is accurate and complete to the best of my
knowledge. I understand that any misrepresentation and/or falsification of any fact may result in
cancellation of employment or immediate dismissal.
I recognize that in connection with employment with _____ , I may be subject to a background enquiry
and hereby authorize the same.
Letter of Authorization
I hereby authorize Vanguard Screening Solutions Inc., to verify information provided in the above form
for Pre-Employment purposes. I authorize all persons who may have information relevant to this enquiry
to disclose it to Vanguard Screening Solutions Inc. and its partners, associates, and release all persons
concerned from liability on account of such disclosure. I hereby voluntarily affix my signature and
represent this document to be an original.
I further authorize the procurement of a consumer credit report or other like documents and
understand the report may contain information on my background, mode of living, character, and
personal reputation.
I further acknowledge, consent and agree that photocopies of this Letter of Authorization may be made
and used as if they were original copies.
Signed : May 12, 2023
Full Name : JAZREEL JADE T. QUEMADO
Date of Birth : 08/10/1995 (DD/MON/YYYY)
Identification : _____________________
Date : May 12, 2023
