Date Submitted: _____________
FORM – STATEMENT OF INTEREST FOR EMPLOYMENT
Save the Children Philippines, Inc. February 2015
POSITION APPLIED FOR:
PERSONAL DATA
Last Name
First Name
Name
Name of Extension (JR/SR/III)
Middle
Nickname:
Address:
Permanent Address:
Phone/Land Line:
Mobile Phone:
Email Address:
Skype ID:
Birthdate:
Citizenship:
Social Security No:
(Required before hiring)
Tax Identification No:
Philhealth No:
HDMF No:
EDUCATIONAL
BACKGROUND
Post Graduate
Tertiary
Secondary
School and Address
Licenses or
Certified
Membership to
any trade /
Profession
From
Type
To
Degree Earned
Date of Issue
Honors/Awards
Received
Rating
Where did you learn about the job posting? [ ] Save the Children Website [ ] Professional Networks [ ] Others: Specify
____________
What interests you most about Save the Children?
What made you apply for this position?
What in your experience, brings out your best and most successful performance? Please give example of this action.
Are there other jobs or types of work which you have an interest or talent for but you are not sure you can qualify?
Skills and Qualifications.
Summarize special skills and qualifications that may qualify you for the position (include relevant volunteer work.) Specify not-for-profit,
industry, functional experience. If no NGO (non-government) work experience, where would your skills best fit with us?
Do you have experience in emergency response? Describe the emergency work and projects you did.
Revised February 2015
1
It is important that you provide complete information on your work history.
WORK EXPERIENCE
(Start with current or most recent. Provide as much information as appropriate. Add space and pages as necessary)
Name & Address of Employer / Company
Position held:
Length of Service
Monthly Salary
From
To
Initial
Final
Job Summary
Key Achievements
Name & Address of Employer / Company
Position held:
Job Summary
Reasons for Leaving
(If applicable)
Length of Service
From
To
Key Achievements
Name & Address of Employer / Company
Position held:
Job Summary
Reasons for Leaving
(If applicable)
Length of Service
From
To
Key Achievements
Name & Address of Employer / Company
Job Summary
Position held:
Monthly Salary
Initial
Final
Reasons for Leaving
(If applicable)
Length of Service
From
To
Key Achievements
Monthly Salary
Initial
Final
Monthly Salary
Initial
Final
Reasons for Leaving
(If applicable)
Comments section. Or also any additional information you would like us to consider.
(Explain any gaps in employment in this section)
Name
Department/ Unit
Relationship
Name those you know
and know you who
are/were employed by
Save the Children.
State what your
relationship is.
REFERENCES
Individuals outside of
the organization who
can vouch for your
work and character;
may include partners,
community leaders, and
representatives of
donor organization.
NOT including family
and friends.
Name
Relationship with
Candidate
Email Address
Contact Number
Person to Contact in Case of Emergency
Name:
Address:
Revised February 2015
Telephone No.:
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Have you ever been hospitalized or operated on?
[ ] Yes
[ ] No
Have you taken a recent physical examination? For what purpose?
What is the present condition of your health? [ ] Poor
- If yes, state nature:
[ ] Yes
[ ] Good
[ ] No
- If yes, state nature:
[ ] Excellent
Have you taken any illegal substance/drugs in the last 12 months?
If Yes, please state what kind of substance/drugs, frequency of use, reasons for taking, if any, etc.
Have you ever been named or involved in a criminal, civil or administrative case involving violations of child protection laws including but
not limited to child abuse and sexual exploitation, violence against women and children and others? If so, please describe the nature of the
case, when it took place, the judgment rendered. [ ] Yes [ ] No - If yes, state nature
Have you ever been named or involved in an administrative case leading to disciplinary action with any previous employer, whether or not
such case was closed or resolved in your favor, or if it is still on-going as of the end of your current or immediate past employment? If so,
please describe the nature of the case, when it took place, the sanction/s given if any, or the conclusions made. (Note: Administrative
cases vary in type and magnitude: samples include but not are not limited to password or security violations, violation or non-compliance
with policy, unethical immoral other socially or commercially unacceptable behavior, inappropriate behavior, grievances filed against an
employee, allegations of sexual harassment, fraud). [ ] Yes [ ] No - If yes, state nature
Have you ever been named or involved in a case before any administrative or judicial body such as a court, barangay, municipality, city or
province where a hearing was conducted and where questions on character – ethics, morality or social and commercial matters - were
involved? If so, please describe the nature of the case, when it took place, the judgment rendered. [ ] Yes [ ] No - If yes, state nature
Have you been convicted of any crime?
[ ] Yes
[ ] No
- If yes, state nature:
I certify this Statement of Interest with Save the Children Philippines for employment or commission for services. I further certify that all
statements made in this application, to the best of my knowledge, are true and that I have not knowingly withheld any fact or
circumstance which would, if disclosed, affect my purpose and business with Save the Children. I understand that any false information
will be sufficient cause for termination at any time if employed or commissioned by contract for services. I also authorize any of the
persons and organizations listed on this application to give any and all information concerning my previous employment, education and
qualifications for employment and for Save the Children to check / verify any information contained in this application. I also authorize
Save the Children to undertake any other necessary inquiries, including criminal record checks and reference checks. I understand that in
this connection, if Save the Children comes to negative findings as a result of reference checks before and after start of employment, that
were not disclosed in this SOI, this can constitute a ground for termination of employment for failure to disclose relevant information.
I also certify that I understand the personal commitment in protecting children’s rights expected from a member of the Save the
Children organization. This includes zero tolerance in violation of children’s rights involving child physical, emotional or sexual abuse or
neglect including condoning or participating in unsafe or abusive behavior towards children and inappropriate behavior or language that is
discriminatory, demeaning, degrading, abusive or sexual. These are documented in the Child Safeguarding Policy to which every
employee acknowledges.
I understand that Save the Children carries a full spectrum programming where there is focus on development work and also on
emergency response work. Employees are called to serve in the appropriate capacity on short notice when and where an emergency
response is called for in the exigency of service.
FULL SIGNATURE:
Revised February 2015
DATE:
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