Human Resource Information System

Last Name

First Name

Middle Name

Middle Initial

Name Extension

Nickname

Citizenship

Filipino

Dual Citizenship

Natural Born / by Birth

Naturalized

Indicate country

Present Address

No.

Street

Village / Town

City

Province

ZIP Code

Staying at Own house

Renting

Staying with Relatives

Provincial Address

Same as present address

No.

Street

Village / Town

City

Province

ZIP Code

Contact Number

Telephone Number

Cellphone Number

Email Address

Date Of Birth

Age

Birth Place

Sex

Height (ft.)

Weight (kg)

Religion

Civil Status

SSS No.

PAGIBIG No.

TIN

GSIS No.

Philhealth No.

Languages / Dialects Spoken

Interests / Hobbies / Past Time

Other Skills / Can operate or use (machines/equipment/software)

Other Special Qualifications, Book Published, Article written

Education List

Level

Name Of School

Basic Education /Degree /Course

From

Highest level /Unit Earned

Year Graduated

Scholarship/Academic Honors Received

Remove

Are you a Fresh Graduate?

Yes

Are you a Government Employee (with Plantilla Position)?

Yes

ADD DETAILS:

Is Government Service?

Yes, if with Plantilla or Signed Appointment Paper

No, (For Private, and Government Service with NON-Plantilla Position)

Date From

Date To

Is Present?

Position Title

Department / Agency / Office / Company

Status of Appointment

Salary Grade

Monthly Salary

Separation Date

Separation Mode

Work Experience List

Government Service

Date From

Date To

Position Title

Agency / Department

Status of Appointment

Salary Grade

Monthly Salary

Separation Date

Separtion Remarks

Edit

Delete

Learning and Development List

Title of Learning and Development Internventions /Training Program Attended

From

Number of Hours

Type Of LD

Conducted /Sponsored By

Local/Foreign

Attachment

Remove

Eligibility List

Note: For Presidential Decree 907, please input N/A on the “Rating” field.

Career Service

If Others please specify

Rating (If Applicable)

Date of Examination /Conferment

Place of Examination /Conferment

License Number (If Applicable)

Date of Validity

Remove

Instructions: Please include immediate family members only. (if single, immediate family members include parents and siblings. If married immediate family members include spouse, children, parents, siblings)

Spouse / Parents / Siblings

Full Name	Birthdate	Age	Relation	Profession/Occupation	Company / Agency	Remove

Children's Information

Surname	First Name	Middle Name	Sex	Date of Birth (mm/dd/yyyy)	Disability	Remove

Medical History

Birth Mark

Blood Type

Allergies

Physical Defect / Major Surgery / Illnes

Do you wear glasses / contact lenses

Character Reference (Non - Relative)

Give at least six (6) Please include direct supervisor from jobs or interships (most recent), co-workers who undestand the value of your accomplishment and subordinated, If any. If you dont have any work experience, you can also consider people you know from volunteer civic or church activities and teachers/professors.

Name

Relation

Position

Company

E-mail Address

Contact Number

Remove

Relatives in the Government

Include third (3rd) level consanguinity, affinity and common law partnership.

Name

Relation

Agency

Occupation / Position

Remove

Have you ever been accused of indicted/tried for the violation of any law, ordinance or regulations before any court or tribunal, or have you ever been accused/charged, or tried for any breach of infraction of military, naval or constabulary discipline in an administrative action?

YES

If YES, give the date and state the nature of offense and penalty

Have you ever been previously retired or were you given separation pay?

YES

If YES, please indicate amount

Are you related by consanguinity or affinity to the appointing or recommending authority, or to the chief of bureau of office or to the person who has immediate supervision over you in the Office, Bureau or Department where you will be appointed?

a. within the third degree?

YES

b. within the fourth degree?

YES

If YES, give details:

Have you ever been found guilty of any administrative offense?Have you ever been criminally charged before any court?

YES

Status of Case/s

If YES, give details:

If YES, give details, Date Filed:

In Case of Emergency

Name

Relation

Address

Phone No.

Requirements

Name Of Attachment

File

Remove

Declarations

All information I have supplied in this application are to the best of my knowledge, true and correct.

I understand that this authorizes the management of the Department of Energy to conduct background investigation/checks and/or similar means to verify the content of my application.

I understand, further, that (a) any deliberately untrue/inaccurate information or false statement I made in my application; or (b) any relationship of mine, whether by consanguinty or affinity, which fall under the Rule of Nepotism found in the Merit Selection Plan of the Department, shall be sufficient cause of disqualification of my application, and can consanguinity, affinity and common law partnership as basis for my dismissal (if and when hired).

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Republic of the Philippines

Kagawaran ng Enerhiya

DEPARTMENT OF ENERGY

Energy Center, 34th St., Rizal Drive, Bonifacio Global City Taguig City, Philippines 1632

ONLINE APPLICATION

WARNING: Any misinterpretation made in this form shall cause the filing of administrative/criminal case/s against the person concerned. ( DO NOT ABBREVIATE )

Present Address

Provincial Address

Contact Number

ADD DETAILS:

Note: For Presidential Decree 907, please input N/A on the “Rating” field.

Instructions: Please include immediate family members only. (if single, immediate family members include parents and siblings. If married immediate family members include spouse, children, parents, siblings)

Spouse / Parents / Siblings

Children's Information

Medical History

Character Reference (Non - Relative)

Relatives in the Government

In Case of Emergency

Requirements

Declarations