DOLE-GIP_Form A
DOLE REGIONAL OFFICE
GOVERNMENT INTERNSHIP PROGRAM (GIP)
APPLICATION FORM
INSTRUCTION TO APPLICANTS:
Please fill-out all the required information in this form and attach additional documents, where necessary.
1. NAME OF APPLICANT:
Family Name First Middle Name
Name
2. RESIDENTIAL ADDRESS: ATTACH 2x2 PHOTO WITH NAME AND
SIGNATURE TAKEN WITHIN THE LAST THREE
(3) MONTHS
Telephone No.:
Mobile Number:
E-mail Address:
3. PLACE OF BIRTH (city/province)
4. DATE OF BIRTH (mm/dd/yyyy) / /
5. GENDER Male Female
6. CIVIL STATUS Single Married Widow/Widower
7. EDUCATIONAL ATTAINMENT
INCLUSIVE DATES
NAME OF SCHOOL From To DEGREE OR DIPLOMA
CERTIFICATION: I certify that all information given in this application are complete and accurate to the best of my knowledge. I
acknowledge that I have completely read and understood the DOLE-GIP Guidelines as embodied in Administrative Order No. ,
Series of 2013.
DATE SIGNATURE OF APPLICANT
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FOR DOLE-RO/FO Use only
Interviewed and validated by:
NAME and SIGNATURE/Position DATE
Documents Received:
Transcript of Records
Barangay Certification
Endorsed by:
District/Partylist Representative, where applicable
