EMPLOYEE HISTORY SHEET
I. PERSONAL INFORMATION
1. FIRST NAME ID picture taken within
the last 6 months
MIDDLE NAME 3.5 cm. X 4.5 cm
(Passport size)
LAST NAME
2. DATE OF BIRTH 3. CITIZENSHIP: If holder of dual By Birth By Naturalization
citizenship, please provide
By Marriage By Descent
the name of both countries,
4. PLACE OF BIRTH
how the citizenship was By Adoption Other
acquired (by
Male Female birth/naturalization), and Pls. Indicate Country:
5. GENDER passport or identification
details.
Single Married
6. CIVIL STATUS Widowed
7. RESIDENTIAL ADDRESS
Separated Other
8. MOBILE NO.
9. PERMANENT ADDRESS
10. E-MAIL ADDRESS
II. FAMILY BACKGROUND
NAME RELATIONSHIP DATE OF BIRTH OCCUPATION CONTACT NO.
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL BASIC EDUCATION DETAILS PERCENTAGE/
LEVEL PASSING YEAR
(Write In Full) (Write In Full) GRADE
ELEMENTARY
SECONDARY
SENIOR SECONDARY
COLLEGE
IV. WORK EXPERIENCE
(Complete work experience details are provided in the attached CV, including company names, positions, and duration of service.)
INCLUSIVE DATES POSITION TITLE LAST DRAWN SALARY
(MM/DD/YYYY) COMPANY NAME (Write In Full/do Not SALARY EXPECTATION
(Write In Full/do Not Abbreviate) Abbreviate) (Per Annum) (Per Annum)
FROM TO
V. TRAINING DETAILS
SR. NO DEPARTMENT TRAINING NAME CONDUCTED BY MONTH & YEAR CERTIFICATE NAME
VI. BACKGROUND VERIFICATION & SELF DECLARATION
A) Within the Third Degree?
☐ YES ☐ NO
1. Relationship with Company Authorities If YES, give details:
B) Within the Fourth Degree?
☐ YES ☐ NO
A). Have you ever been found
guilty of any administrative offense
in any organization (Government or
Private)?
If YES, please provide details:
2. Administrative / Legal Record ☐ YES ☐ NO
B) Have you ever been criminally
charged before any court of law?
☐ YES ☐ NO
A) Have you ever been convicted
of any crime or violation of any law,
3. Criminal Conviction ordinance, rule, or regulation by If YES, please provide details:
any court or tribunal?
☐ YES ☐ NO
A) Have you been a candidate in
any national or local election within If YES, please provide details:
4. Political Involvement the last one (1) year?
☐ YES ☐ NO
A) Have you acquired immigrant or
5. Immigration Status permanent resident status in any If YES, specify country and status details:
foreign country?
☐ YES ☐ NO
A) Are you a member of any
Indigenous Community/Group?
☐ YES ☐ NO
6. Special Category Declaration If YES, specify country and status details:
B) Are you a Person with Disability
(PWD)?
☐ YES ☐ NO
C) Are you a Solo Parent?
☐ YES ☐ NO
VII. REFERENCES
(Person not related by consanguinity or affinity to applicant /appointee)
PLATFORM NAME USERNAME PURPOSE (PERSONAL/PROFESSIONAL) CONTACTS NUMBER
LinkedIn
Facebook
Instagram
Twitter (X)
Other
VIII. AUTHORIZED SIGNATURE
MANAGING DIRECTOR
PLANT HEAD HUMAN RESOURCES (HR) DEPARTMENT HEAD
(MD)
WARNING: As per the company rules and regulations, any misrepresentation, concealment of facts, submission of false information, or incorrect details in the
personal data sheet (PDS) and work experience sheet shall be treated as a serious misconduct. Such act may lead to disciplinary action, including termination of
employment, and may also result in administrative and/or criminal proceedings against the concerned individual as deemed appropriate by the management.
All applicants / employees are strictly advised to read the attached “guide to filling out the personal data sheet (PDS)” carefully before submitting the form.