Applicant Personal Background Form

Q
DEVELOPMENT BANK OF THE PHILIPPINES DBP-Resources for Inclusive & Sustainable Education (DBP-RISE)

Basic Instructions:
1. Please fill out ALL required information. Incomplete form shall not be accepted for processing.
2. Type or print all entries clearly and use additional sheets if necessary. Indicate N/A if not applicable. Do not leave blanks. Staple a recent
3. Please submit fully accomplished form in duplicate (2) copies. 2x2 ID picture with your
4. Attach the following documents: printed name and signature
☐ Application letter expressing willingness to abide by the ☐ Recommendation letter from high school principal at the back.
DBP-RISE policies & guidelines attesting to moral character & school performance.
☐ Two copies of 2x 2 ID pictures (staple in the box
☐ Income Tax Return or other proof of family income
provided above)
☐ Photocopy of grades/Form 138/ NCAE result. ☐ Copy of PSA/Local Birth Certificate

Nickname
RESPONDED TO
☐ Newspaper /TV Advertisement ☐ Walk-in ☐ Write-in / Email ☐ Others
☐ Campus Recruitment ☐ Referral by:
Specify:

PERSONAL DATA
Last Name First Name Middle Name Maiden Name (If married)

Age Date of Birth MM-DD-YY Place of Birth Citizenship Civil Status Religion Sex

Present Address Contact Number

Telephone/Fax (Present Address)

House/Floor Unit No. Block No./Lot. No./Phase No./Bldg Name Street Name Subdivision/Village/Purok/Sitio/Barrio
Mobile No.

Barangay Town/Municipality/City/District/State Province/Region Country Zip Code

Provincial Address
Landline No. (Provincial Address)

House/Floor Unit No. Block No./Lot. No./Phase No./Bldg Name Street Name Subdivision/Village/Purok/Sitio/Barrio
Email Address

Barangay Town/Municipality/City/District/State Province/Region Country Zip Code

INCOME AND ASSETS
Annual Family Income Main Source

Own Car ☐ Yes ☐ No Estimated Value

House ☐ Yes ☐ No Estimated Value

Other Assets
Estimated Value
(Farm, Store, etc.)

Person to contact in case of emergency:

Address:
Telephone / Cellphone Number: Email Address

EDUCATIONAL BACKGROUND
Level School Last Attended/ Address Public/ Private Year Graduated Honors/ Awards

GOVERNMENT EXAMINATION/S TAKEN

Title of Examination Date of Examination MM-DD-YY Place of Examination Rating

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 EMPLOYEMENT RECORD (Start from most recent. Indicate history of employment since 15th birthday; whether on a permanent, temporary or casual basis)
Inclusive Dates MM-DD-YY Reason for
Position Employer Address of Employer
From To Leaving

OTHER INFORMATION (Use additional sheet if necessary)

1. Filipino Reading: ☐ Good ☐ Fair Speaking: ☐ Good ☐ Fair Writing: ☐ Good ☐ Fair
Languages/Dialects 2. English Reading: ☐ Good ☐ Fair Speaking: ☐ Good ☐ Fair Writing: ☐ Good ☐ Fair
(Indicate actual
proficiency level): 3. Reading: ☐ Good ☐ Fair Speaking: ☐ Good ☐ Fair Writing: ☐ Good ☐ Fair
4. Reading: ☐ Good ☐ Fair Speaking: ☐ Good ☒ Fair Writing: ☐ Good ☐ Fair
Computer Literacy 1. Microsoft Word/ Similar programs: ☐ Yes ☐ No
(Indicate if you can use
2. Microsoft Excel/ Similar programs: ☐ Yes ☐ No
the programs
independently) 3. Microsoft PowerPoint/ Similar Programs: ☐ Yes ☐ No
1. 3.
Other Skills:
2. 4.

Hobbies/ Interests:

Height: (cm) Eyes: Complexion: Other Distinguished

Physical Description: Features:
Weight: (kg) Hair: Built:

RESIDENCE OF MORE THAN SIX (6) MONTHS DURATION FROM 15 TH BIRTHDAY

Inclusive Dates MM-DD-YY
Complete Address
From To
10/09/2020 10/09/2020
10/09/2020 10/09/2020

FAMILY BACKGROUND (Use additional sheets if necessary.)

Name of Spouse (if married) Age Address of Spouse

Date of Marriage MM-DD-YY Place of Marriage Occupation of Spouse Spouse’s Employer/Address

Parents and In-laws Age Address Occupation/Employer

Father
Mother
Father-in-Law
Mother-in-Law

Name of Dependents Age Relationship Date of Birth MM-DD-YY

Name of Brothers and Sisters Age Occupation/Employer Civil Status

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 ADDITIONAL INFORMATION (Please mark your response. Use additional sheets if necessary.)
1. Have you ever been found guilty or been penalized for any offense or violation involving moral turpitude? If yes,
please check nature of offense, and specify name of court or administrative board and disposition of case:

☐ Yes ☐ No ☐ Administrative ☐ Civil ☐ Criminal

Provide Details: ____________________________________________________________________________

2. Have you ever been hospitalized for a period of six months or undergone treatment for any illness or disease that is
☐ Yes ☐ No not curable within six months? If yes, please provide details:
______________________________________________

3. Have you applied for DBP-RISE Scholarship before? If yes, please provide details:
Date : _____________________
☐ Yes ☐ No
Venue: ______________________
Status: ______________________
4. Do you have any relative within the fourth degree of consanguinity or affinity working in DBP? If yes, please provide details:
Name of Relative/s: 1. ______________________ Relationship: 1. ______________________
☐ Yes ☐ No 2. ______________________ 2. ______________________
3. ______________________ 3. ______________________
REFERENCES (Kindly provide details of at least three (3) persons not related to the applicant by consanguinity or affinity.)
REMINDER: Children and relatives of DBP and Partner Schools employees within the 3rd degree of consanguinity and affinity are
disqualified under the DBP-RISE Scholarship.
Contact Details
Name Occupation Address
(Telephone/Cellphone)

I hereby certify that all the information/details above are true complete, accurate and correct to the best of my knowledge and belief. This serves as an
authorization to conduct investigation on my personal background. Any false information contained herein may be grounds for cancellation and termination
of DBP-RISE Scholarship.

I also read and understand the Privacy Notice of DBP and expressly consent to the processing of my personal and/or sensitive personal information in the
manner and for the purpose provided in the Bank’s Notice. I understand and accept that this will include access to personal date and records
submitted, which can be regarded as personal and/or sensitive personal data as provided under the Data Privacy Act of 2012.

Likewise, I authorize DBP to disclose our data to accredited/affiliated third parties or independent/non-affiliated third parties, whether local or foreign, in the
following circumstances:

• As necessary for the proper execution of processes related to the declared purpose.
• The use or disclosure is reasonably necessary, required or authorized by or under law; and
• Provided security systems are employed to protect my data.

Date Accomplished Applicant’s Signature over Printed Name

FOR MINOR APPLICANTS: (15-17 Years old)

Father’s Signature over Printed Name Mother’s Signature over Printed Name Guardian’s Signature over Printed Name

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