IPAMS General Evaluation Form
IPAMS General Evaluation Form
IPAMS General Evaluation Form
RECRUITER:
ASSESSMENT DATE:
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Full Name
(Last Name) (First Name) (Middle Name)
Current Address
Cellphone No.
Email address
Backup Cellphone No.
Highest Educational ☐ Junior High School ______ - ______ ☐ Graduate Associate Degree Undergraduate ______ - ______
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First name Middle name Last name
Please put a Check (✓) under the YES or NO column if you were diagnosed of the following conditions, and indicate treatment/corrective
procedures done prior to this application:
Medical Condition YES NO Write Treatment/Corrective Procedure
If you have undergone any surgical procedure / operation or removal of tumor/mass, please submit operative record including biopsy /
histopathology and your attending specialist’s medical report to include date, procedure done, and prognosis of condition. (WRITE N/A on
the space if NOT Applicable)
If you are currently taking any medication, please indicate what medicine / drug and for what illness / disease (WRITE N/A on the space if NOT
Applicable)
SECTION 141. Grounds for Disciplinary Action and their Penalties. Commission by an OFW of any of the offenses enumerated
below shall be a ground for disciplinary action for which the corresponding penalties shall be imposed.
1. SERIOUS OFFENSES. Serious offenses are punishable by One (1) Year-and One (1) Day to Two (2) Years suspension from
participation in the overseas employment program.
a. Submitting, furnishing or using falsified document or employing any other forms of misrepresentation for the purpose of job
application or employment.
B. CONFLICT OF INTEREST
I hereby undertake to not engage in any conflict of interest. Should I sign 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 also warrant that I have acquired the consent from all parties involved in my application and hold free and harmless and
indemnify IPAMS from any complaint, suit or damages, which party may file or claim in relation to issues surrounding my
application to IPAMS.
In compliance with Data Privacy Act (DPA) of 2012, and its Implementing Rules and Regulations (IRR) effective since September
8, 2016, I allow and authorize IPAMS to continue to use, retain my information for a period of six (6) months and agree that
my information will be deleted/destroyed after this period. I also understand that my consent does not prevent the existence of
other criteria for lawful processing of personal data in relation to IPAMS’ operations. I also allow IPAMS to share my information
to third parties (government agencies, IPAMS clients and associates – overseas or local employment) which are necessary for any
of IPAMS’ legitimate business purpose with IPAMS’ assurance that security systems are employed to protect my personal
information and sensitive personal information.
Text messages or conversation between myself and IPAMS staff will not be shared as it is STRICTLY CONFIDENTIAL and only to
be used for my application. I understand that SCREENSHOTS and posting them in any social media platform is PROHIBITED.
Such action will be SUBJECT FOR DISQUALIFICATION of my application even if I am chosen as a shortlist candidate for the job
I applied.
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