APPLICATION FOR EMPLOYMENT PLEASE

VALIANT DISTRIBUTION, INC. ATTACH

1X1
McKENZIE DISTRIBUTION, CO., INC. PHOTO
#86 E. Rodriguez Jr. Avenue, Libis, Quezon City
(632) 638-2660 to 66
http://www.mdci.com.ph

Fill out this form completely. Type or print legibly. Please attach your recent 1x1 colored ID photo, comprehensive
resume & transcript of academic records. Information provided is confidential and will only be used by authorized
personnel.

Date: ________________________________ Position: ________________________________

PERSONAL INFORMATION

Name ___________________________________________________________ Nickname ___________________

Last First Middle
Address _______________________________________________________________________________________
Number & Street Barangay Town/District
___________________________________________________________ Telephone No. _______________
City/Province Zip Code
Provincial ________________________________________________________________________________________
Address Number & Street Barangay Town/District
__________________________________________________________ Telephone No. ________________
City/Province Zip Code
Mobile No.____________________ Email Address ________________________ Fax No. ______________________
Place of Birth _________________ Date of Birth _________________________ Age ________________________

Gender: Civil Status: SSS No. ________________________

 Male  Single  Widowed TIN No. ________________________
 Female  Married  Separated Philhealth No. ________________________
Drivers License No: __________________ Restriction: ____________ Pag-Ibig No. _________________________

EDUCATION

YEAR COMPLETED?
DEGREE / HONORS
SCHOOL / LOCATION FROM TO If not, no. of units
completed
MAJOR RECEIVED
Elementary

High School

College

Post-
Graduate

Other Studies

FAMILY BACKGROUND

Father’s ____________________________ Age _____ Occupation ________________ Employer _____________

Name
Mother’s ____________________________ Age _____ Occupation ________________ Employer _____________
Name
Spouse’s _____________________________Age_____Occupation_________________Employer______________
Name

Siblings (Please attach additional sheet if necessary)

Name Age Civil Status Occupation School
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Children of applicant (Please attach additional sheet if necessary)

Name Age Civil Status Occupation School
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

1
 EMPLOYMENT HISTORY (FROM PRESENT BACKWARDS)

Employer 1
Company Name Address
Position / Designation Immediate Supervisor
Employment Dates Contact No.
Salary Reason for Leaving
Person to be contacted: ________________________________ Telephone No. ______________________________

Employer 2
Company Name Address
Position / Designation Immediate Supervisor
Employment Dates Contact No.
Salary Reason for Leaving
Person to be contacted: ________________________________ Telephone No. ______________________________

Employer 3
Company Name Address
Position / Designation Immediate Supervisor
Employment Dates Contact No.
Salary Reason for Leaving
Person to be contacted: ________________________________ Telephone No. ______________________________

Are you presently employed?  YES  NO

May we contact your current employer?  YES  NO
If no, please state reason/s:
_________________________________________________________________________________________________
If yes, please provide the name, designation and contact details of the person to be contacted
_____________________________________________________________________________________________

Expected Salary for the position applying (minimum to maximum): ____________________________________________

OTHER INFORMATION

YES NO
1. Do you have any major health problems at present?  
If yes, please describe.
2. Have you ever been convicted by a court of law?  
If yes, please provide date/s and convictions.
3. Do you have pending debts and credit obligations?  
If yes, please provide details.
4. Have you ever been dismissed from employment because of misconduct?  
If yes, please provide details.
5. Are you willing to work overtime, or night shifts if required by company?  
If not, please state reason/s.
6. Are you willing to accept out of town assignments?  
If yes, please state preferred area/s of assignment.
7. Do you have any relatives employed with the company?  
If yes, please state name and position.
8. How did you learn about the job vacancy in the company? ____________________________________________

REFERRALS: List down three (3) names and contact details of people you know for your referrals.
Name Occupation Contact Detail/s
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

DECLARATION:

I hereby declare that the above information given by me in this application for employment is true to the best of my
knowledge, information and belief. I further attest that I have declared all the information required to be given in this
application and that I have not withheld any material, fact or information which may affect my application. I
understand that withholding information relevant to my application will be sufficient ground for dismissal subsequent to
engagement. I further understand that permanent employment shall be contingent upon meeting all the requirements,
including undergoing the necessary pre-employment medical examination with a satisfactory result as a pre-requisite,
and I hereby authorize the company to undertake the necessary checks.

____________________________ ____________________________
Signature of Applicant Date