PKI MANUFACTURING & TECHNOLOGY, INC.

Lot 14, Phase 1-A, First Philippine Industrial Park, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

LU

FRANCIS IVAN

Surname

Birthdate

Given Name

Jun 25, 1985

Place of Birth:

Nationality:

FILIPINO

Address:

Block 11 Lot 3 South Villa Maa , Davao city

Contact No.:

Sex:

Attach

BATALLER
Middle Name

Davao City

Age:

Male

29

Blood Type:

9295567276

Passport No.:
Date of Expiry:

2" x 2" photo

with white
background
O

E-mail Address:

jovanlu08@gmail.com

Philhealth No.:

16-025588775-8

Pag-ibig No.:

(not more than 6 mon

old)

SSS No.:

n/a

n/a

TIN:

Father's Name:

Lu, Eduardo

Occupation:

n/a

Birthdate

Feb 2,

1960

Age:

Mother's Name:

Lu, Arlene Bataller

Occupation:

Accountant

Birthdate

Mar 2,

1960

Age:

Civil Status:

single

( Single, Married, Widow/er, Separated )

Spouse Name:

Occupation:

Birthdate

Age:

No. of Children:
Childs Name

Birthdate

Sex

Childs Name

Birthdate

Sex

Emergency Contact Details :

Name:

Arlene B.Lu

Contact Num. :

Have you been to Japan?

No

Name

(Yes/No)

Relationship

Relationship:

mother

If yes, indicate the no. of times and the

date(s)

( Yes/No)

Do you have immediate family in Japan?

9272447762

If yes, please enter the following details below:

Birthdate

Nationality

Place of Employment/School

Res. ID

EDUCATIONAL BACKGROUND (Starting Elementary to College)

Month/Year

Major

School / University

Month/Year

Major

School / University

June 1991

Holy Child School Of Davao

-Enrolled

June 2009

BSCE

Jose Maria College

-En

March 1997

Holy Child School Of Davao

-Graduated Nov 2013

BSCE

Jose Maria College

-Un

June 1998

Holy Child School Of Davao

-Enrolled

March 2003

Holy Child School Of Davao

-Graduated

EMPLOYMENT BACKGROUND (Please fill out the form below, start with oldest employer to the most recent)
Month/Year

Position

Company

DEC 2011

SCAA

Task Force Davao

-Employed

MARCH 2012

SCAA

Task Force Davao

-Resigned

Waiter

Monteritz Sports And Leisure Axis

-Employed

Month/Year

Position

2014

Merchandiser

Company
Activation Machine (uniliver)

-Re

-Resigned
(Other activities not mentioned on the dates above)
From

To

Activity

-Em

From

To

Activity

APR 2015

(October 2013)

PRESENT

FRONTLINE NIHONGO STUDIO DAVA

Signature over printed name

k, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

Attach
2" x 2" photo
with white
background
(not more than 6 months
old)

n/a

55
55

Sex

mother

Res. ID .No.

School / University
-Enrolled
-UnderGrad

Company
-Employed
-Resigned

Activity

Signature over printed name

PKI MANUFACTURING & TECHNOLOGY, INC.

Lot 14, Phase 1-A, First Philippine Industrial Park, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

DE LA CRUZ

MARIA

BONIFACIO

Surname

Given Name

Birthdate

Jan 27, 1978

Place of Birth:

Nationality:

Filipino

Sex:

Address:

Middle Name

Tanauan Batangas

Age:

Male

23

Blood Type:

No.123 Labanos Street, Purok Bahay Kubo,

Contact No.:

0917-717-1111

E-mail Address:

Passport No.: XXX1234

Date of Expiry:

juandelacruz@yahoo.com

Philhealth No.:
Jan 27, 1978

12345

Pag-ibig No.:

SSS No.:

12345678

1010 0

TIN:

Father's Name:

Dela Cruz, Juanito

Occupation: Employee

Birthdate

Mar 29,

Mother's Name:

Dela Cruz,Jasmine

Occupation: Employee

Birthdate

Mar 29,

Birthdate

Dec 1,

Civil Status:

Single

( Single, Married, Widow/er, Separated )

Spouse Name: Dela Cruz, Ramos Devina

No. of Children:

Occupation: Housewife

5 (five)

Childs Name

Birthdate

Sex

Childs Name

Dela Cruz, Peter

Jan 1, 2008

Male

Dela Cruz, Petra

Jan 9, 2009

Female

Dela Cruz, Pasta

Feb 10, 2010

Female

Birthdate

Dela Cruz, Pepe

Mar 1,

Dela Cruz, Purisma

Jun 22,

Emergency Contact Details :

Name:

Dela Cruz, Juanito

Have you been to Japan?

Contact Num. :

Yes

( Yes/No)

Do you have immediate family in Japan? Yes

Name

(Yes/No)

Relationship

Dela Cruz, Jasmine

Relationship:

If yes, indicate the no. of times and 2 times - 1st: Apr 12

2012; 2nd: Feb 14, 2013
the date(s)
If yes, please enter the following details below:

Birthdate

Mother

0916-110-123456

Jan 1, 1974

Nationality

Filipino

Employer/School & Address

Hitachi Corp - Fukuoka-shi Shizuoka
Japan

EDUCATIONAL BACKGROUND (Starting Elementary to College)

Month/Year

Major

School / University

Jun 1996

--

Sky Elementary School

Mar 2000

--

Sky Elementary School Transfer

Jun 2000

--

Star Elementary School

-Enrolled

BS Marketing

Sky University

Mar 2002

--

Star Elementary School

-Graduated Apr 2010 BS Marketing

Sky University

-Enrolled

Month/Year

Major

Jun 2002

--

Sky High School

Mar 2006

--

Sky High School

Jun 2006

School / Univ

EMPLOYMENT BACKGROUND (Please fill out the form below, start with oldest employer to the most recent)
Month/Year

Position

Company

May 2011

Prod. Staf

ABC Company

-Employed Oct 2012

Store Clerk

SM Megamall

Oct 2011

Prod. Staf

ABC Company

-Resigned

Apr 2014

Store Clerk

SM Megamall

Mar 2012

Prod. Staf

ASS Factory

-Employed

Jul 2014

Warehouse Staf PKIMT Inc.

Sep 2012

Prod. Staf

ASS Factory

-Resigned

Present

Warehouse Staf PKIMT Inc.

(Other activities not mentioned on the dates above)

Month/Year

Position

Compan

From

To

Activity

May 2010

May-11

Job Hunting

Nov 2011

Feb-12

XYZ Nihongo School - Basic 1 Nihongo

From

To

May 2014

Jun-14

Activity
Jobless

Signature over p

k, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

1010 00011

1979 Age:

40

1979 Age:

41

1989 Age:

24

Birthdate

Sex
2011

Male

2012

Female

Father
2 times - 1st: Apr 12, 2012 to Jun 11,
2012; 2nd: Feb 14, 2013 to May 13, 2013

Employer/School & Address

Hitachi Corp - Fukuoka-shi Shizuoka
Japan

Res. ID .No.

A12345BC

School / University
Sky High School

-Enrolled

Sky High School

-Graduate

Sky University

-Enrolled

Sky University

-Graduate

Company
SM Megamall

-Employed

SM Megamall

-Resigned

PKIMT Inc.

-Employed

PKIMT Inc.

Activity
Jobless

Signature over printed name

PKI MANUFACTURING & TECHNOLOGY, INC.

Lot 14, Phase 1-A, First Philippine Industrial Park, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

2
Surname

Given Name

Birthdate
Nationality:

FILIPINO

Middle Name

Place of Birth:

Age:

Sex:

Blood Type:

(not m

Address:
Contact No.:

E-mail Address:

Passport No.:

Philhealth No.:

SSS No.:

Pag-ibig No.:

TIN:

Date of Expiry:
Father's Name:

Occupation:

Birthdate:

Mother's Name:

Occupation:

Birthdate:

Civil Status:

( Single, Married, Widow/er, Separated )

Spouse Name:

Occupation:

Birthdate:

No. of Children:
Childs Name

Birthdate

Sex

Childs Name

Birthdate

Emergency Contact Details :

Name:

Contact Num. :

Have you been to Japan?

Name

If yes, indicate the no. of times and the

date(s)

( Yes/No)
(Yes/No)

Do you have immediate family in Japan?

Relationship

Relationship:

If yes, please enter the following details below:

Birthdate

Nationality

Place of Employment/School

EDUCATIONAL BACKGROUND (Starting Elementary to College)

Month/Year

Major

School / University

Month/Year

--

-Enrolled

--

-Graduated

--

-Enrolled

--

-Graduated

Major

School / Un

EMPLOYMENT BACKGROUND (Please fill out the form below, start with oldest employer to the most recent)
Month/Year

Position

Company

Month/Year
-Employed

Position

Compa

-Resigned

(Other activities not mentioned on the dates above)

From

To

Activity

From

To

Activ

Signature ove

ark, Brgy. Sta. Anastacia, Sto. Tomas, Batangas

Attach
2" x 2" photo
with white
background
(not more than 6 months
old)

Age:
Age:

Age:

Birthdate

Place of Employment/School

Sex

Res. ID .No.

School / University
-Enrolled
-Graduated

Company

Activity

Signature over printed name