GENERAL EVALUATION FORM

PERSONAL INFORMATION (CANDIDATE PROFILE)

Let’s get you started by building a comprehensive profile. IPAMS trusts that you will treat this evaluation form as essentially vital for your application. All
applications will be valid for six months from the date of pre-screening. Our recruiters will match your qualifications across our list of available jobs for
you. If you have not received feedback within six months or have failed your interviews with any of our clients, please update your profile at the
http://www.ipams.com/Jobseeker. All information will be treated confidential and shall only be used for recruitment purposes.

Name (Last, First, Middle Name) Asagra, Claire, Gernale

Position Applied For house keeping supervisor/any work that can apply my Date of Birth (dd/mm/yy) 14/09/1993
Email Address [email protected] Gender Female
Cellphone No. 09491209192 Date of Availability anytime
Skype ID claireasagra06 Passport Validity (dd/mm/yy) 26/09/2019
Source Area (City/Province) Manila Height (ft.) & Weight (lbs.) 5'3 /145 lbs
Latest - Basic Salary (PHP) 20,000 Expected – Basic Salary (PHP)

IPAMS Website
Workabroad.ph Word of Mouth
IPAMS Mobile App
Jobstreet.com POEA Referral
Facebook
Newspaper/Radio Ad PESO
Instagram/Twitter/LinkedIn
Flyering & Headhunting Others (pls. specify)
Job Fair
Date: Provincial Sourcing REFERRED BY:
Venue: Date: Name:
Venue: Company:
Position:
TO BE FILLED-OUT BY IPAMS RECRUITMENT TEAM

I. SCREENING AND VERIFICATION:

Competency Based Assessment English Proficiency Assessment
Date Taken/Score: Date Taken/Score:

Watch listing: POEA Watchlist IPAMS ORION Employee Relations

II. RECRUITER’S PORTFOLIO

Please put a (X) mark if you have submitted the following documents to IPAMS at the time of application.
* CIVIL * ACADEMIC * EMPLOYMENT * OTHERS
Post Graduate Diploma Employment Certificates 3-page IPAMS Application
Passport/proof of release
(Masters/PHD) Form
Employment Contract IPAMS Online Application
NBI Clearance PRC Board Certificate/ID
Form
Foreign Police Clearance College Diploma Appointment Letter FOR DOCS UNLISTED
Birth Certificate Transcript of Records Pay slips (use the space below)
Marriage Certificate High School Diploma Final Exit Clearances
No Objection Certificate,
POEA OFW Information Copy of Grades/Form 137
if available
PEOS Certificate TESDA National Certificates Exit Stamps
SSS Employment History TESDA Vocational Courses Company IDs
TESDA Trainings/Trade Tests Trainings and Seminars
Driver’s License
Attended

III. EVALUATION AND RECOMMENDATION

EVALUATED BY: Status: Shortlisted Failed For manpower pooling

STATEMENT OF UNDERSTANDING
I acknowledge that I have read, understood and agreed to the content of this application form and hereby give my full consent to IPAMS to utilize all information for
the purpose of matching my qualifications against available jobs. I confirm that my application with IPAMS is voluntary. I understand and agree that should I fail to
meet the Company’s physical tests in the Philippines and at the job site (abroad), or if for any reason, it is determined that I may not be employed, the Company
shall not be held liable for loss or damages.
I hereby undertake to not engage in any conflict of interest. Should I already signed up or have already been selected for a particular principal, I am waving my chance
to be endorsed to other principals, unless IPAMS would state otherwise. I certify that all statements I have made in this application are true and any misrepresentation
or deliberate omission of facts is sufficient grounds for cancelation of my application and cause for immediate dismissal. Should I be found culpable of this act, I will
reimburse IPAMS any processing cost it incurred including applicable damages and penalties as may be imposed by the principal. Should this application be denied,
IPAMS has no obligation to furnish any reason for rejection

Claire G. Asagra 30/06/2021

APPLICANT SIGNATURE DATE SIGNED
Please sign over printed name (dd-mm-yy)

Recruitment Form 007 – 1 General Evaluation Form for website(Front)

Revised May 28, 2020
All rights reserved, no part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior written permission of IPAMS Recruitment Team
 Claire Gernale Asagra
First Name / Middle Name / Family Name

Please complete this form and declare fully all medical conditions. Failure to do so can
mean cancellation of your application.

Date of last Medical Examinations: Name of Medical Facility / Place :

Please put a Check (√) under the YES or NO column if you were diagnosed having
the following conditions, and indicate treatment /corrective procedures done prior to this application:

Medical Condition YES NO Treatment / Corrective

Procedure
Tuberculosis / PTB ✔

Asthma ✔

Skin Disease(s) / Allergy ✔

Hepatitis “B” (HBSAG) ✔

Hepatitis “C” ✔

Renal / Kidney Disease ✔

Heart Disease ✔

Hypertension ✔

Diabetes ✔

Thyroid Problem ✔

Hernia ✔

Body Tattoos ✔

Vision (specify condition) ✔

Hearing (specify condition) ✔

Scoliosis (indicate degree) ✔

Other Physical Deformities

✔
(ex. Gunshot or stab wounds, trauma, etc.

 If you have undergone surgical operation, please explain and

Indicate the date, nature and other information

 If you are currently taking any medication, please indicate what

Medicine / drug and for what illness / disease

CERTIFIED CORRECT:

Applicant Signature

Recruitment Form 006 – 1 General Evaluation Form - website (Back)

Revised May 28, 2020
All rights reserved, no part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior written permission of IPAMS Recruitment Team