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FM-EW-013 - 1 - SPES Application Form

This document is an application form for the Special Program for Employment of Students (SPES) in the Philippines. It collects personal information from applicants such as name, address, education history, and parental information to determine eligibility for the program.

Uploaded by

Arianne Atay
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23 views

FM-EW-013 - 1 - SPES Application Form

This document is an application form for the Special Program for Employment of Students (SPES) in the Philippines. It collects personal information from applicants such as name, address, education history, and parental information to determine eligibility for the program.

Uploaded by

Arianne Atay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF LABOR AND EMPLOYMENT SPES Form 2


IV-A
Regional Office No. _______
PUBLIC EMPLOYMENT SERVICE OFFICE
______________________________
City/Municipality/Province
SPECIAL PROGRAM FOR EMPLOYMENT OF STUDENTS (SPES)
(RA 7323, as amended by RAs 9547 and 10917)

APPLICATION FORM
Control No.: __________________

SURNAME FIRST NAME MIDDLE NAME GSIS BENEFICIARY/RELATIONSHIP

DATE OF BIRTH: (mm/dd/yyyy) PLACE OF BIRTH: CITIZENSHIP:

PRESENT ADDRESS: Passport Size Picture


(3.5cm x 4.5 cm)
PERMANENT ADDRESS:

CELPHONE NO.: EMAIL ADDRESS:

SOCIAL MEDIA ACCOUNT (FACEBOOK, TWITTER, INSTAGRAM, ETC.)

STATUS SEX Student ALS student out-of-school (OSY)


Single Married Widow/er Separated Male Female
CURRENT STATUS OF PARENTS: Living together Solo Parent Separated Person With Disability Senior Citizen
Sugar Plantation Worker Indigenous People Displaced Worker (1) Local (2) OFW
FATHER’S NAME /CONTACT NO.: MOTHER’S MAIDEN NAME/CONTACT NO.:

OCCUPATION: OCCUPATION:

EDUCATION NAME OF SCHOOL DEGREE EARNED/COURSE YEAR/LEVEL DATE OF ATTENDANCE


Elementary
Secondary
Tertiary
Tech-Voc
DOCUMENTARY REQUIREMENTS:
(Original and other documents, when applicable, should be presented for validation)
1) Photocopy of Birth Certificate or any document indicating date of birth or age (age must be 15-30)
2) Photocopy of the latest Income Tax Return (ITR) of parents/legal guardian OR certification issued by BIR that the
Parents/guardians are exempted from payment of tax OR original Certificate of Indigence OR original Certificate
of Low Income issued by the Barangay/DSWD or CSWD where the applicant resides; and
3) For students, any of the following, in addition to requirements no. 1 and 2:
a) Photocopy of proof of average passing grade such as (1) class card or (2) Form 138 of the previous semester
or year immediately preceding the application; OR
b) Original copy of Certification by the School Registrar as to passing grade immediately preceding
semester/year if grades are not yet available
4) For Out of School Youth (OSY), original copy of Certification as OSY issued by DSWD/CSWD or the authorized
Barangay Official where the OSY resides, in addition to requirements no. 1 and 2.
SPECIAL SKILLS:

HISTORY of SPES Availment/ Name of Establishment YEAR SPES ID NO. (if applicable)
st
1 Availment
2ndAvailment-
3rdAvailment
4thAvailment
Other related information/ requests/ interventions from DOLE:

I hereby attest that the information above are true and correct to the best of my knowledge, including the attached documents /
requirements which I also attest as to their veracity. I agree that any false statement would cause the automatic disqualification/ cancellation
of the service/ contract/ grant and I shall refund amount received and/or pay damages to DOLE or comply with other sanctions in accordance
with law. Any material change in my financial status may affect my eligibility to continue the program.
____________________________________
Signature of Applicant

FM-EW-013.1 Effective 01/17/17

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