APPLICATION FOR EMPLOYMENT
Picture
(Passport size)
Instructions: This form is an official document. Please answer all
items. If an item is not applicable to you, indicate NA or Not Applicable.
Please check ( ) the appropriate box whenever applicable.
Have you taken BSP pre-employment test
before?
Yes
No
Position Applied For:
1.
SURNAME
FIRST NAME
MIDDLE NAME
2. CIVIL STATUS
Single
For female married applicant: write Maiden Name
3. GENDER
Married
Separated
5. DATE OF BIRTH
6. AGE
Widower/Widow
Male
7. PLACE OF BIRTH
8. HEIGHT (Meters)
10. PERMANENT ADDRESS
Female
11. E-MAIL ADDRESS
Name and Address of
School/College/ University
13. EDUCATION
4. CITIZENSHIP
9. WEIGHT (Kilos)
12. CONTACT NUMBER
Course
(If Undergraduate, indicate
no. of units completed)
Inclusive Dates of
Attendance
Honors
Received
Secondary
Vocational
College
Postgraduate
(Continue on separate sheet, if necessary)
14. CIVIL SERVICE ELIGIBILITY/LICENSE
(specify if BOARD, BAR, etc.)
Rating
15. SKILLS AND OTHER QUALIFICATIONS
16. MEMBERSHIP IN RELATED
ASSOCIATION, HOBBIES, etc.
(Continue on separate sheet, if necessary)
17. SEMINAR/TRAINING ATTENDED
Title of Seminar/ Training
Inclusive Dates
No. of Hours
(Continue on separate sheet, if necessary)
18. EMPLOYMENT HISTORY
Inclusive dates
(Exact dates)
Position Title and
Status of Appointment
Monthly
(specify if Permanent, Probationary
Temporary, Casual, Contractual, etc.)
Name and Address of
Company/Agency/Office
Basic Salary
Allowances
Reason for
Leaving
(Continue on separate sheet, if necessary)
HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012
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19. Are you related to any official or employee in the BSP:
a.) within the third degree of consanguinity (i.e. mother/father,
If yes, give name/s of relative/s and relationship/s
son/daughter, brother/sister, nephew/niece, uncle/aunt,
grandparent, grandchild)?
Yes
No
b.) within the second degree of affinity (i.e. mother-in-law/ father-in-
law, son-in-law/daughter-in-law, brother-in-law/ sister-in-law)?
Yes
No
other relative/s not specified in items a and b?
c.)
Yes
No
20. Do you have relative/s who was/were former employee/s of the
Bangko Sentral ng Pilipinas?
Yes
No
21. Have you ever been a respondent for a preliminary investigation
before the Prosecutor’s/ Fiscal’s Office or any law enforcement
agency such as the police, PDEA, NBI, etc.?
Yes
No
a)
an administrative case?
Yes
No
b)
a criminal case?
Yes
No
23. Have you ever been convicted of any administrative offense
Yes
If yes, give name/s, relationship, department and date of
retirement
If “Yes”, state nature of the offense complained of
Status:
On-going
Dismissed
Status:
On-going
Acquitted
Dismissed
If “Yes”, state nature of the offense/case and penalty
No
24. Have you ever been retired, forced to resign or dropped from
employment whether in the public or private sector?
Yes
If yes, give name/s of relative/s and relationship/s
If “Yes”, state nature of offense/crime
22. Have you ever been charged of
or crime?
If yes, give name/s of relative/s and relationship/s
If “Yes”, give reasons
No
25. Have you ever been a candidate in a national or local election
(except Barangay election)?
Yes
No
If "Yes", give details
26. Please check any ailment/s for which you have been treated or are presently undergoing treatment
hypertension
diabetes
acquired heart disease
kidney disease
pulmonary tuberculosis
27. What is the minimum salary
you are willing to accept?
chronic pulmonary disease
malignancies/cancer
hematologic condition
autoimmune disease
cardiovascular Accident (CVA)
neuro-psychiatric condition
chronic liver disease
major congenital anomaly/deformation
others: _____________________________
_____________________________
28. FOR APPLICANTS TO A SECURITY GUARD POSITION ONLY
If considered, are you willing to be assigned/re-assigned to the Main/SPC/regional offices/branches of the
Bangko Sentral ng Pilipinas in the performance of your job?
Yes
No
Signature __________________________________
29. REFERENCES (Persons not related by consanguinity or affinity to applicant)
Name
Address/ Telephone No.
1.
_____________________________________________
___________________________________________
2.
_____________________________________________
___________________________________________
3.
_____________________________________________
___________________________________________
I declare that the answers given above are true and correct to the best of my knowledge and belief. It is understood that any false
representation I made above shall disqualify me from employment in the BSP in which case, my appointment, if one is issued, shall be
revoked; such representation shall be a ground for an administrative case for DISHONESTY and/or CONDUCT PREJUDICIAL TO THE BEST
INTEREST OF THE SERVICE punishable under the disciplinary rules on administrative cases both in Civil Service Commission and BSP.
I further waive my right to confidentiality of information pertaining to the BSP Watchlist clearance in compliance with
M.B. Resolution No. 1487.
Signature over Printed Name/ Date
HR Form No. 02-001 (AOM Form No.01-080) * Version: 4 * Updated: 30 August 2012
Community Tax Certificate No.
________________
Issued at
________________________________
Issued on
________________________________
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