Form Revision Date 30 January 2022
EMPLOYEE INFORMATION SHEET
FULL NAME: _________________________ ____________________ _________________________ POSITION: ___________________
LAST NAME FIRST NAME MIDDLE NAME
BIRTHDATE(MM/DD/YY): _ ___/_ ___/ _ _ _ GENDER(M/F): ______ RELIGION: _______________
PHONE NUMBER/S: ________________ MOBILE NUMBER/S: __________________ EMAIL: ____________________
SSS NO: ___-_________________-_______ PHILHEALTH:
__________________________________
TIN: ________-____________-____________ PAG-IBIG: _____________-______________-
__________
TAX STATUS: SINGLE_________ MARRIED: _________ NO OF QUALIFIED DEPENDENTS: __________________
Former UAS Employee?
Y ⃝ N ⃝ Details ____________________
Have you ever been convicted?
Y ⃝ N ⃝ Details ____________________
COMPLETE ADDRESS:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
HIGHEST EDUCATIONAL ATTAINMENT: ____________________________ DEGREE TAKEN:__________________________________
COMPLETE SCHOOL NAME: ___________________________________________
WORK EXPERIENCE/S
COMPANY NAME POSITION TITLE INCLUSIVE DATES OF EMPLOYMENT
______________________________________ __________________________________________ FROM___________ TO ___________
______________________________________ __________________________________________ FROM___________ TO ______________
______________________________________ __________________________________________ FROM___________ TO ______________
______________________________________ __________________________________________ FROM___________ TO ______________
______________________________________ __________________________________________ FROM___________ TO ______________
______________________________________ __________________________________________ FROM___________ TO ______________
SOURCE: (Check the box corresponding to Source and provide the details)
SOURCE DETAILS SOURCE DETAILS
INTERNET SCHOOL AND BUSINESS
PARTNERSHIP
JOB FAIR SIGNS AND DISPLAYS
MEDIA SMS
PRINT MEDIA WALK IN
REFERRAL WORD OF MOUTH
IN CASE OF EMERGENCY, NOTIFY:
NAME: _________________________________ RELATIONSHIP: _______________________ CONTACT NUMBER: ________________
I acknowledge and reaffirm that the information submitted to the company with respect to my employment application, including any
supporting materials, is complete and accurate, I understand that submitting false or incomplete information could result in my termination.
Name and Signature of Applicant / Date
