NSRP form 1 September 2020 Republic of the Philippines Department of Labor and Employment NATIONAL SKILSS REGISTRATION PROGRAM JOBSEEKER REGISTRATION FORM INSTRUCTIONS: Please fill out the form legibly in block letters using a ballpoint pen. Check appropriate boxes. Please do not leave any items unanswered. Indicate “NA” if not applicable. You may use extra sheet if needed. Submit accomplished form to the Public Employment Service Office (PESO) Manager or Officer in your city/municipality . I. PERSONAL INFORMATION ---------------------------------------------------------------------------------------------------------SURNAME FIRST NAME MIDDLE NAME DATE OF BIRTH (mm/dd/yyyy) _________________________________ SEX RELIGION _____ MALE ______ FEMALE CIVIL STATUS ______ Single ______ Married ______ Widowed TIN NO. ___________________________ DISABILITY ____Visual ___Speech ____Mental ___Hearing __Physical __ others Please specify: ________ EMPLOYMENT STATUS/TYPE ____ Employed ___Wage employed ___Self-employed (pls. specify) _____ Fisherman/Fisherfolk _____Vendor/Retailer _____Home-based worker _____ Transport ____Domestic Worker _____ Freelancer _____Artisan/Craft Worker ______Others (pls. specify): Are you an OFW? ___Yes ____No Specify country: ____________________ Are you a 4Ps beneficiary? ____Yes ____No II. JOB PREFERENCE PREFERRED OCCUPATION _____ Part-Time ______ Full-Time ---------------------------SUFFIX (Ex. Sr., Jr., etc.) PRESENT ADRESS House No./ Street Village Barangay Municipality City Province HEIGHT (FT.) CONTACT NUMBER/S E-MAIL ____ Unemployed How long have you been looking for work? (months) ________ ______New Entrant/Fresh Graduate ______Finished Contract ______Resigned ______Retired ______Terminated/Laid off due to calamity ______Terminated/Laid Off(abroad) Specify country: ___________________ ______ others, please specify: __________________ Are you a former OFW? _____Yes _____No Latest country deployment: ___________________ Month and year Return to Philippines? _____________________ if yes, please provide Household ID No. __________________________ 1. PREFERRED WORK LOCATION ____ Local _______ Overseas, (specify (specify countries) cities/municipal ities 1. 1 2. 2. 2. 3. 3. 3. III. LANGUAGE/DIALECT PROFICIENCY (check if applicable) LANGUAGE/DIALECT READ English Filipino Mandarin Others: _________ WRITE SPEAK UNDERSTAND IV. EDUCATIONAL BACKGROUND Currently in school? ___ Yes _____No LEVEL SCHOOL/COURSE YEAR GRADUATED IF UNDERGRADUATE LEVEL REACHED YEAR LAST ATTENDED Elementary Secondary Senior High School Tertiary Graduate Studies/PostGraduate V. TECHNICAL/VOCATIONAL AND OTHER TRAINING (Include courses taken as part of college education) TRAINING/VOCATIONAL COURSE HOURS OF TRAINING TRAINING INSTITUTION SKILLS ACQUIRED CERTIFICATES RECEIVED (NC I, NC II, NC III, NC IV, etc.) 1. 2. 3. VI. ELIGIBILITY/ PROFESSIONAL LICENSE CAREER SERVICE/BOARD/BAR LICENSE NUMBER DATE TAKEN VALID UNTIL 1. 2. VII. WORK EXPERIENCE (Limit to 10 year period, start with the most recent employment) COMPANY NAME VIII. ADDRESS (City/Municipality) POSITION NUMBER OF MONTHS STATUS (Permanent, Contractual, Part-time, Probationary) OTHER SKILLS ACQUIRED WITHOUT CERTIFICATE ____ AUTO MECHANIC ____ BEAUTICIAN ____ CARPENTRY WORK ____ COMPUTER LITERATE ____ DOMESTIC HORES ____ DRIVER _______ ELECTRICIAN _______EMBROIDERY _______ GARDENING ______ MASONERY ______ PAINTER/ARTIST ______ PAINTING JOBS ______ PHOTGRAPHY ______PLUMBING ______ SEWING DRESSES ______ STENOGRAPHY ______ TAILORING ______OTHERS: ___________ CERTIFICATION/AUTHORIZATION This is to certify that all the data/information that I have provided in this form are true to the best knowledge. This is also to authorize DOLE to include my profile in PESO Employment Information System and use my personal information for employment facilitation. I am also aware that DOLE is not obliged to seek employment on my behalf. __________________________ ___________________ Signature of Applicant Date FOR USE OF PESO ONLY, PLEASE DO NOT WRITE BELOW THIS DOTTED LINE. ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------Referred to: ___ SPES _____ DILEEP ___ GIP _____ TESDA Training ___ TUPAD ___ Jobstart __ Others, specify: _________ Assessed by: ______________________________ Signature over Printed Name of Assessor _____________ Date
