Dole Sena Form 1

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PLEASE PRINT CLEARLY.

USE BLUE INKED PEN


(KLARUHIN ANG PAGSULAT. GUMAMIT NG ASUL NA BALLPEN )
DOLE-SENA Form No.1 Republic of the Philippines Date Filed: (DD/MM/YY)
(Request for Assistance Form)
Department of Labor and Employment
NATIONAL CONCILIATION AND MEDIATION BOARD
CENTRAL OFFICE
5th Floor Arcadia Building, #860 Quezon Avenue, Quezon City

SINGLE-ENTRY APPROACH (SEnA)


(Per Department Order No. 107, Series of 2010)
Reference No. : SEAD-NCMB-CO-_____-______-________-2020
Name of Requesting Party : Name of Responding Party: (Agency/Company/Corporation/Establishment)
A1+ MULTINATIONAL PACKAGING, INC./STARKSON
(Pangalan) GUARDIANS FEDERATION OF WORKERS (GFW) AND (Pangalan) PACKAGING, INC., AND ORO-B MULTIFEAT MANAGEMENT
ITS CHARTERED MEMBERS HEADED BY ROMEO DG. SERVICES/GEORGE T. CO/ROBERTO T. CO AND
ESCANO, JR., ET-AL. OSCAR ROSARIO BERNABE, ET-AL.,
Please check () Male Female Please check () Male Female
Union Company Union Company

Address : # 45 B.M.A. Avenue, Brgy. Tatalon, Quezon City, Metropolitan Nature of Business : packaging materials, paper and plastic
(Tirahan) Manila

Total No. of Employees : 2,000

Male Female
Telephone/Cellphone/Fax/eMail Address: 0917-5765188 -0961-3499560
Contact Person :
(Taong Kakausapin sa Kumpanya) Mr. George T. Co and
Mr. Roberto T. Co
Date of Employment : July 29,2010 Position : (President/Chairman/Manager/Other)
(Kailan napasok sa trabaho) (Katungkulan) President and General Manager

Years of Service : 10 years and 10 months Address : # 255 Katipunan Ave., Novaliches, Quezon City
(Taon sa Serbisyo) 45 KM Aguinaldo Highway, Brgy. Luksuhin, Silang, Cavite
Nature of Work: Delivery Helper Telephone/Cellphone/Fax/eMail Address: 0917-5351299
(Trabaho)

CLAIMS/ISSUES RELIEF PRAYED FOR ACTION TAKEN


(Please check the appropriate box/es) (Anong gusto niyong solusyon sa reklamo/problema) (To be filled-out by SEnA Desk Officer)

a) Money claims
Non-payment/underpayment of: Payment of Money Claims Advise and Counseling
Wage Reinstatement Set a Joint Conference on
Overtime Pay Cessation of ULP Acts
Night Shift Differential Pay Restitution/Correction of violations Settlement Agreement signed on
Service Incentive Leave of Occupational Safety and Health
Holiday Pay Standards Withdrawal of either or both parties
SSS Conduct Certification Election Referred to
PHILHEALTH Conduct of Election of Union Officers BY REASON OF:
PAG-IBIG Audit/Examination of Union Funds Failure of the parties to reach
b) Unfair Labor Practice (ULP) Others (Please Specify) an agreement within the 30-day
c) Illegal Dismissal mandatory conciliation-mediation
d) Illegal Dismissal with Money Claims PRINT NAME AND SIGNATURE period
(PANGALAN AT LAGDA) Failure of the requesting party to
e) Non-Compliance with Occupational
Health and Safety Standards 1. ROMEO DE GUZMAN ESCANO, JR. appear in two (2) scheduled con-
f) Certification Election Dispute 2. Chartered Union President secutive conferences despite due
g) Inter/Intra-Union Dispute 3. notice.
h) Cancellation of Union Registration 4. Pre-termination of the proceedings
i) Others (Please Specify) 5. with request of issuance of Refer-
LEONCIO G. PAGHUNASAN ral from
National President
REMARKS:
Requesting Party Signature

SEnA DESK OFFICER


(Signature over Printed Name)

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