NOTE: Indicate below your chosen job Vacancy/ Job Title:
1. Number and Job Title: ________________________
2. Number and Job Title: _______________________
Republic of the Philippines
Department of Labor and Employment
PESO EMPLOYMENT INFORMATION SYSTEM
REGISTRATION FORM
NSRP FORM 1
January 2017
1x1 Photo
INSTRUCTIONS: Please fill out the form legibly with ballpen. Print in block letters. 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 Manager or Officer in your City / Municipality.
I. PERSONAL INFORMATION
SURNAME
DATE OF BIRTH (mm/dd/yyyy)
SEX
RELIGION
CIVIL
STATUS
TIN
GSIS / SSS ID NO.
PAG – IBIG NO.
PHILHEALTH NO.
DISABILITY
EMPLOYMENT
STATUS / TYPE
FIRST NAME
MIDDLE NAME
SUFFIX (Ex: Sr., Jr., III, etc.)
PLACE OF BIRTH
NAGA CITY, CAM. SUR
FEMALE
PRESENT ADDRESS
House No. / Street
Village
Barangay
Municipality /City
Province
HEIGHT
EMAIL ADDRESS
LANDLINE NUMBER
CELLPHONE NUMBER
Others, specify:
_____________
MALE
Single
Married
Widowed
Separated
Live - in
Visual
Hearing
Speech
Physical
Employed
Wage
Employed
Self
Employed
Unemployed
New Entrant / Fresh
Graduate
Finished Contract
Terminated / Laidoff (local)
Terminated/ Laidoff (abroad)
Specify country ________________
Others, specify ______________
Resigned
Retired
Are you actively looking for work
Willing to work immediately?
Are you a 4Ps beneficiary?
II. JOB PREFERENCE
PREFERRED OCCUPATION
1.
2.
1.
3.
2.
4.
3.
Expected Salary (Range)
III. LANGUAGE /DIALECT PROFICIENCY
(check if applicable)
READ
English
Filipino
Others: ______________
Yes
Yes
Yes
No
No
No
How long have you been looking for work? _________
If no, when?
If yes, Household ID No. ___________
PREFERRED WORK LOCATION
Local, specify cities / municipalities:
Overseas, specify countries:
1.
2.
3.
Passport No.
Expiry date
WRITE
SPEAK
UNDERSTAND
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IV. EDUCATIONAL BACKGROUND
If not graduate,
SCHOOL
COURSE
Year
Graduated
What
level?
Awards
received
Year last
attended
Elementary
Secondary
Tertiary
Graduate Studies
V. TECHNICAL/VOCATIONAL AND OTHER TRAINING (Included courses takens as part of college education)
TRAINING / VOCATIONAL COURSE
DURATION
Training Institution
Certificates Received
(mm/dd/yyyy to mm/dd/yyyy
(NCI,NCII,NCIII,NC IV, etc.)
1.
2.
3.
VI. ELIGIBILITY / PROFESSIONAL LICENSE
ELIGIBILITY (Civil Service) Rating
Date of examination
PROFESSIONAL LICENSE (PRC)
1.
1.
2.
2.
VII. WORK EXPERIENCE (Limit to 10 year period, start with the most recent employment)
Company Name
Address
Position
Inclusive Dates
(City Municipality)
(mm/yyyy to mm/yyyy)
VIII. OTHER SKILLS ACQUIRED WITHOUT FORMAL TRAINING
AUTO MECHANIC
ELECTRICAL
BEAUTICIAN
EMBROIDERY
CARPENTRY WORK
GARDENING
COMPUTER LITERATE
MASONRY
DOMESTIC CHORES
PAINTER/ARTIST
DRIVER
PAINTING JOBS
CERTIFICATION / AUTHORIZATION
Valid Until
Status
(Permanent, Contractual Parttime, Probationary
PHOTOGRAPHY
PLUMBING
SEWING DRESSES
STENOGRAPHY
TAILORING
OTHERS: __________________
This is to certify that all data/ information that I have provided in this form are true to the best of my knowledge. This is also to authorized
the DOLE to include my profile in the PESO Employment Information System, which ia subsystem of the PhilJobNet. It is understood that my
name shall be made available to employers who have access to the Registry. 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.
Eligible for public employment services?
Assessed by:
SPES
GIP
TUPAD
___________________________________
JobStart
Signature over Printed Name of Assessor
Others, specify: ________________
___________
Date
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