Jessa M.
Villacorta
B.A. Psychology - IV
MIDTERM/ SEMI-FINALS
Psychological Interview
(PSY 27)
Permit #.
INTERVIEW SCHEDULE
Educational Setting
Counseling Setting
Industrial Setting
Hiring
Grievances with Employees
Mini Research
EDUCATIONAL SETTING: Pre-school and Elementary
Note: the parents or guardian of the student are asked to fill this form.
VILLACORTA SPECIAL SCHOOL SYSTEM, INC.
-oOo-
STUDENT’S INFORMATION SHEET
NAME: _____________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
ADDRESS: _______________________________________ TEL. NO. _________________________
DATE OF BIRTH: __________________ SEX: _______ PLACE OF BIRTH: __________________
NAME OF PARENTS:
FATHER: __________________________________________ OCCUPATION: _________________
BUSINESS ADDRESS: ____________________________________ TEL. NO. __________________
MOTHER: _________________________________________ OCCUPATION: _________________
BUSINESS ADDRESS: ____________________________________ TEL. NO. __________________
EDUCATIONAL SETTING: Secondary
VILLACORTA SCIENCE HIGH SCHOOL
-oOo-
STUDENT’S INFORMATION SHEET
Year: __________________ Section: _______________
Date: __________________
Name__________________________________________
(Last) (First) (Middle)
Sex_________________ Nationality__________________ Religion__________________
Date of Birth ___________________________ Place of Birth________________________
Home Address _________________________________ Telephone No. ______________
_________________________________ Mobile No. ________________
_________________________________
Elementary School Graduated From _____________________________Sch. Yr. _______
Address of School/Location _____________________________________
_____________________________________
Father’s Name ________________ Age ___________ Birthplace ____________________
Education _______________ Occupation ______________ Place of Work_____________
Living ( ) Dead ( ) Cause of Death _____________________________________
Living with the Family ( ) Yes ( ) No Abroad ( ) Separated ( )
Mother’s Name ________________ Age ___________ Birthplace ___________________
Education _______________ Occupation ______________ Place of Work _____________
Living ( ) Dead ( ) Cause of Death ____________________________________
Living with the Family ( ) Yes ( ) No ( ) Abroad ( ) Separated
No. of Children in the Family: Brothers ___________ Sisters _________
Stepbrothers _______ Stepsisters _________
Housing condition ( ) Owned ( ) Shared with grandparents or relatives
( ) Rented ( ) Rent to Own
Subject Liked Best _________________________ Subject Liked Least _______________
Hobbies ______________________________________________________________________
Special Talents ________________________________________________________________
Clubs/Organizations Joined ___________________________________________________
Ambition _____________________________________________________________________
Course you intend to take after high school ____________________________________
In case of emergency please contact: _____________________
Relation: _____________
Address: _____________________
Mobile No. ___________________
EDUCATIONAL SETTING: Tertiary
VILLACORTA UNIVERSITY
-oOo-
STUDENT’S INFORMATION SHEET
PERSONAL DATA
NAME: ___________________________________________ AGE:_________ SEX:_______
LAST NAME FIRST NAME MIDDLE NAME
ADDRESS: _______________________________________ TEL. NO. ___________________
DATE OF BIRTH: __________________ PLACE OF BIRTH: _____________
CIVIL STATUS: __________ NATIONALITY
FATHER’S NAME ____________ AGE ___________ BIRTHPLACE ____________________
EDUCATION ___________ OCCUPATION ___________ PLACE OF WORK_____________
MOTHER’S NAME _____________ AGE ___________ BIRTHPLACE ___________________
EDUCATION __________OCCUPATION ___________ PLACE OF WORK _____________
CHECK WHICH APPLIES TO YOU:
______ NEW STUDENT
______ OLD STUDENT
______ TRANSFEREE
______ SHIFTER
UNITS EARNED: __________________
COUNSELING SETTING: for counseling information it would be best to have a
highly scheduled fill up form to gather essential data about the counselee these
may provide a to background review for the counselor before proceeding with a
non-scheduled interview.
HIGHLY SCHEDULED
VILLACORTA UNIVERSITY
Guidance Center
Calasiao, Pangasinan
-oOo-
COUNSELEE’S INFORMATION SHEET
Purpose: to draw together all essential information about you that might help in your
counseling session. If some questions are misunderstood feel free to ask your counselor
for clarifications. All information would be kept confidential
PERSONAL DATA
Name__________________________________________ Nickname _________________
(Last) (First) (Middle)
Sex_________________ Nationality__________________ Religion__________________
Date of Birth ___________________________ Place of Birth________________________
Home Address _________________________________ Telephone No. ______________
_________________________________ Mobile No. ________________
________________________________ Civil Status _________________
FAMILY BACKGROUND
Father’s Name ________________ Age ___________ Birthplace ____________________
Education _______________ Occupation ______________ Place of Work_____________
Living ( ) Dead ( ) Cause of Death _____________________________________
Living with the Family ( ) Yes ( ) No Abroad ( ) Separated ( )
Mother’s Name ________________ Age ___________ Birthplace ___________________
Education _______________ Occupation ______________ Place of Work _____________
Living ( ) Dead ( ) Cause of Death ____________________________________
Living with the Family ( ) Yes ( ) No ( ) Abroad ( ) Separated
No. of Children in the Family: Brothers ________ Sisters _________
Stepbrothers _____ Stepsisters ______
Housing condition ( ) Owned ( ) Shared with grandparents or relatives
( ) Rented ( ) Rent to Own
Only answer this portion if married.
Name of Spouse________________ Age ___________ Birthplace ___________________
Education _______________ Occupation ______________ Place of Work ____________
Living ( ) Dead ( ) Cause of Death ____________________________________
Living with the Family ( ) Yes ( ) No ( ) Abroad ( ) Separated
No. of Children _________________ Boys _____________ Girls_______________
FAMILY INCOME
Note: Encircle one that applies to you
a. P 5, 000 and below
b. P 5, 001 – P 10,000
c. P 10,001 – P 15,000
d. P 15, 001 – P 20, 000
e. P 20, 000 – above
EDUCATIONAL BACKGROUND
NAME OF SCHOOL YEAR GRADUATED
Elementary _________________________ ______________________
Secondary __________________________ ______________________
Tertiary ____________________________ ______________________
Course: _____________________________
Subject Liked Best _________________________ Subject Liked Least _______________
Hobbies __________________________________________________________________
Special Talents ____________________________________________________________
Clubs/Organizations Joined __________________________________________________
Achievements ________________________________________________________________
_________________________________________________________________
_________________________________________________________________
NON - SCHEDULED
CASE: The counselee (female) was forced by his boyfriend to have sex with him. The
counselee now feels guilt and is bothered by the act she had committed with him. Soon
she found out that she was pregnant and is now scared of her parents finding out.
Counselor: So tell me ________________ what is bothering you?
Counselee: I- uh.. uhm…
(counselor notices the counselee being hesitant and waits for the counselee to find her
words, after a while the counselee, eases.)
Counselee: I have been really bothered for the past few weeks. It all started when my
boyfriend forced me to have sex with him. I really love him and so I agreed even though
I wasn’t sure, but then when we were about to do it I changed my mind I knew I wasn’t
ready yet. Then he forced himself into me. . .(looks away)
Counselor: uh-huh
Counselee: He was sorry afterwards and so I forgave him. Ever since that, I have been
feeling . . . guilty. I came from a pious family I wanted to do it after I get married. I
sometimes console myself by saying I’d only want to do it with him anyway so it wouldn’t
make any difference. .But I really feel guilty and impure now. We didn’t do it with any
protection. . .
(Counselee starts crying, counselor hands a tissue box for her)
Counselee: After a few weeks. I started feeling nauseous and so my boyfriend and I
bought a pregnancy test to check if I am pregnant. And it turns out that I am. I’m scared
to have an abortion, knowing that I’ll be even more bothered by guilt if I do it. I don’t
know how to tell my parents. I’m scared to tell them. I am so ashamed.
Counselor: my dear, you have been feeling guilt since you are a good person and you
aren’t comfortable that you did something wrong. Don’t think that you are impure. Being
pregnant while still studying is a hard situation. It is good that you have all intention to
tell your parents. It’s just that you are scared to tell them how.
Counselee: I am so scared I really don’t know what to do I’ve been really stressed about
it.
Counselor: Don't be too hard on yourself about it it'll only stress you out and
make the situation worse. If you're pregnant, you do know that hiding it isn't
going to do anything but make it worse and make them more mad. Your best
option is to tell you parents. With your mom, I would talk to her really calmly
and just tell her mom I made a mistake and I'm pregnant. I really need your
support to get through this. If she freaks out, give her time to cool down
because it's probably going to be a big shock to her. Same thing with your dad.
Eventually they are going to have to get used to it, accept it, and move forward
with what it is. You'll just have to take it step by step.
Counselee: I’ll really try to talk to them. I don’t know what will happen to me in
the future. People will be talking about me.
Counselor: people will talk even if you’re pregnant or not. What is important is
that you get the support system you need. Your life would not end if you get
pregnant early. For now, you would also need the help of your boyfriend’s
family. So both of you should tell them your situation. You can also make him
come with you for our session after lunch. So that I can talk to you both on
what steps to take.
Counselee: I’ll make him come with me later.
INDUSTRIAL SETTING: HIRING
* Usually an applicant form is provided (highly scheduled) followed by a short
interview (non-scheduled).
HIGHLY SCHEDULED
Villacorta Galleria
Application Form
Insert photo here
Walk-in _______
Job Fair _______
PERSONAL INFORMATION DATE OF
APPLICATION:______________
Name:
___________________________________________________________________________
Last First Middle
Date of Birth: __________ Place of Birth___________Age: ___________ Sex: ________
Civil Status: _____________ Nationality ________________ Religion ______________
Address: ____________________________________________________________________
Alternate Address: __________________________________________________________
Home Telephone:________Mobile Telephone _____________ Email ______________
If married please fill the portion below:
Name of spouse: _________________________ Age: ______ Birthdate: ______________
Date of Marriage_____________ Living, Deceased, Separated: __________________
Number of Children: ______________ Contact number: ________________________
POSITION SOUGHT : _________________________ Available Start Date:__________
Desired Pay Range: ________________ Are you currently employed? _________
Hourly or Salary
EDUCATION
Year
Name and Location Course/ Major
graduated
High School
College or
University
Specialise training,
Trade School, etc
Other Education/
Graduate
Please list your areas of highest proficiency, special skills or other items that
may contribute to your abilities in performing the above mentioned position.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
PREVIOUS EXPERIENCE
Please list beginning from most recent
Dates Employed Company Name Location Role/Title
_______________ ________________________ _________________
_______________
_______________ __________________________ _________________
_______________
_______________ __________________________ _________________
_______________
_______________ ___________________________ _________________
______________
Person’s to contact for verification:
Name of Employer ________________ Contact number: _________________________
Name of Employer ________________ Contact number: _________________________
Name of Employer _________________ Contact number: _________________________
Name of Employer ________________ Contact number: _________________________
NON - SCHEDULED
*If a client has no work experience
HR: so you’re a fresh graduate why do you want to work in our company?
*if a client had several work experiences
HR: what made you leave your previous work?
INDUSTRIAL SETTING: GRIEVANCES
Villacorta Galleria
Employee Grievance Form
Grievant Information
Employee Name: __________________________________________________ Date:
___________________________
Job Title: ___________________________ Employee ID: ________________________
Date of Hire: _______________
Home Mailing Address: ____________________________________________________
Work Mailing Address: _____________________________________________________
Date, time and place of event leading to grievance:
______________________________________________________________________________
_____________________________________________________________________________
Detailed account of occurrence (include names of persons involved, if any):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please state policies, procedures, or guidelines that you feel have been violated:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Proposed solution to grievance:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The grievant should retain a copy of this form for his/her records. The signature
below indicates that you are a filing a grievance, and any information on this
form is truthful.
_______________________________________________ ____________________
Employee Signature Date
________________________________________________ _____________________
Received by Date
NON – SCHEDULED
An (male) employee filed a grievance form against his co-employee who has been
the thief roaming around their office rummaging in each cubicle. A CCTV was
planted in the office and may provide evidence for the other stealing event that
has happened there. His Samsung Galaxy Note was stolen on 3/6/14 during
lunch. The janitress Mrs. Kita saw Mr. Dukot leave his cubicle around 12:40 pm.
He wants Mr. Pavaya to be fired and to return his gadget.
HR: so Mr. Pavaya, this complaint is really desctructive for Mr. Dukot. Once the
CCTV does prove that he did stole your Samsung…… then he can technically get
fired for being harmful in the office since you did say that you weren’t the only
victim of thievery here.
Mr. Pavaya: indeed other employees are willing to file as well for his removal in
this company.
HR: Well then, we’ll have to first look at the CCTV footage of what happened that
time in your office. Then we’ll call on you to come for the results.