APPLICATION FORM

INSTRUCTIONS: Please attached a copy of the following to this form and email back to jgr.hcsi@gmail.com unless the
following has been emailed together with your resume.
1. Resume
2. Birth Certificate
3. NBI Clearance

REFERRED BY:

OTHER COMPANIES YOU HAVE APPLIED TO:

SALARY EXPECTATION:

POSITION APPLYING FOR: First Choice:

Second Choice:

WORK SCHEDULE:
What date are you available to begin work?
Are you willing to work weekends and holidays?

NAME
SURNAME FIRST MIDDLE NICKNAME

CITY
ADDRESS NO. STREET DISTRICT CITY CONTACT NO.

PROVINCIAL ADDRESS
CONTACT NO.
BIRTH
DATE PLACE RELIGION

SEX: HEIGHT: WEIGHT:

O
R

N
A
L
S

TIN: Pagibig ID #:

SSS #: Philhealth ID #

CIVIL STATUS: Single Married Widow

IF MARRIED, NAME OF SPOUSE:_________________________________________________
MAIDEN NAME FIRST NAME MIDDLE
BIRTH DATE PLACE

EMPLOYER OFFICE ADDRESS

PROFESSION SALARY

PERSON TO CONTACT IN CASE OF EMERGENCY:

Contact Person: Contact No.: __________________

Relationship: ___________________________________
Addresss: ________________________________________________________________________________
 YEAR SCHOOL ADDRESS DEGREE
FROM TO

ELEMENTARY

HIGH SCHOOL

COLLEGE

VOCATION

POST GRADUATE
K
G

O
N
A

A
C

U
N
D
L

GRADUATE EXAMINATION TAKEN: BAR ____ BOARD ___ CIVIL SERVICE___ NONE _______

STATE NATURE OF EXAMINATION: YEAR TAKEN:_______________ RATING_____________

ARE YOU PRESENTLY ENROLLED IN ANY SCHOOL:

IF SO, WHERE:

WHAT COURSE: TIME SCHEDULE:

DO YOU LIVE IN : OWN HOUSE WITH RELATIVES

BOARDING HOUSE (Since When)
NAME OF FATHER: PROFESSION:

NAME OF MOTHER: PROFESSION:

NAME OF LIVING BROTHERS/SISTERS AGE PROFESSION

1
2
3
4
5
6
7
8
K
G

O
Y

A
C

U
N
D
B

NAME OF LIVING CHILDREN SEX AGE

1
2
3
4
5

DOES YOUR FAMILY OWN ANY BUSINESS?_________________________________________________

IF YES, PLEASE STATE NATURE: ________________________ LOCATION: _________________
DOES YOUR FAMILY OWN REAL ESTATE?_____________ LOCATION: __________________________
WHAT ARE YOUR OTHER SOURCE OF INCOME: _______________________________________
NAME/ADDRESS OF BANKS OR OTHER CREDIT INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS/LOANS:

ARE YOU A CREDITED CARD HOLDER?__________ IF YES, PLEASE SPECIFY______________________

ARE YOU A GUARANTOR/SUB GUARANTOR OF ANY CREDIT CARD?______________________________

IF YES, PLEASE SPECIFY:

 (from present to previous company)

Start Date: End Date:

Employer/ Company:

Position/ Job Title:

Name of Supervisor:

Contact Information of Supervisor:

Starting Salary:

Last Salary:

Start Date: End Date:

Employer/ Company:

Position/ Job Title:

Name of Supervisor:

Contact Information of Supervisor:

Starting Salary:

Last Salary:
M

O
N

R
Y

End Date:
E

Start Date:
S
I

Employer/ Company:

Position/ Job Title:

Name of Supervisor:

Contact Information of Supervisor:

Starting Salary:

Last Salary:

Start Date: End Date:

Employer/ Company:

Position/ Job Title:

Name of Supervisor:

Contact Information of Supervisor:

Starting Salary:

Last Salary:

Do you have any pending labor case? Yes No

If yes, why?
 Give 5 references who know you well, who are not your relatives:
Full Name Employment Info/ Address Contact No.
A
C

R
R

N
C
T
E

E
F

S
How do you think your strengths can contribute to Hari-Raya?
A
Y
A

R
R

Y
E
S
I

RELATIVES WORKING IN HARIRAYA? (Old or Presently Working in Hari-Raya)

Full Name Position/ Department Relationship

RELATIVES IN FOOD AND BEVERAGE INDUSTRY?

Full Name Employer Relationship

I hereby authorize Hari-Raya Coffee Shops, Inc./ Hari-Raya Lounge & Business Center, Inc. to
thoroughly investigate my background, references, employment record, and other matters related to my
suitabiity for employment. I authorize persons, schools, my current employer (if applicable), and
previous employers and organizations contacted by Hari-Raya to provide any relevant information
regarding my current and/or previous employment and I release all persons, schools, employers of any
and all claims for providing such information. I understand that misrepresentation or omission of facts
may result in rejection of this application, or if hired, discipline-up to and including dismissal. I
understand that I may be required to sign a confidentiality and/or non-complete agreement, should I
become an employee of Hari-Raya Coffee Shops, Inc. or Hari-Raya Lounge & Business Center, Inc. I
understant that nothing contained in this application, or conveyed during any interview which may be
granted, is intended to create an employment contract. I understand that filing out this form does not
indicate that there is a position open and does not obligate Hari-Raya Coffee Shops, Inc. or Hari-Raya
Lounge & Business Center to hire me.

Date Applicant's Signature over Printed Name