Dole Sena Form 1
Dole Sena Form 1
Dole Sena Form 1
Address : # 45 B.M.A. Avenue, Brgy. Tatalon, Quezon City, Metropolitan Nature of Business : packaging materials, paper and plastic
(Tirahan) Manila
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)
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