Philippines Recruitment

DOCUMENT NO.: REC_PH_FRM_2015-005_v1.1 VERSION NO. 1.1

EFFECTIVE DATE 07/13/2015
DOCUMENT NAME: Application Source Form PAGES 1

Candidate Name Alexis Dominic C. San Valentin

Signature and Date of Submission January 13, 2016
Contact Number and Email Address 09157705279 / lexsanval@yahoo.com

NOTE:
The purpose of this form is to confirm how your application was received by IBM. Your input will be our basis to process a potential
bonus pay out to the IBM employee or headhunting agency you will identify. By signing this form, you are certifying the accuracy
and integrity of the data you are submitting to IBM. Any misrepresentation or tampering of information may be used by IBM as
grounds for ineligibility of incentives.

SOURCE OF APPLICATION
How did you submit your application for this job opportunity? Kindly select ONLY ONE among the choices below:

REFERRAL PROGRAM (please select specific source below and provide details)

Internal (IBMer) Name: Serial No.:

How are you related to the referrer/how do you know the referrer?
Are you giving your consent to be processed as a referral of the employee (Y/N?)
External (Non-IBMer) Name:

X ONLINE APPLICATION (please select specific source below and provide details)

Job Boards (ex. JobStreet, Monster, etc.) Jobstreet

Social Media (ex. LinkedIn, Facebook, Twitter, etc.)
Career Portal (ex. IBM Career Website, GOM)

VENDOR (please select specific source below and provide details)

Conversion Name of Vendor & Contact Person:

Direct Placement Name of Vendor & Contact Person:

UNIVERSITY RELATIONS (please select specific source below and provide details)

University Job Fair Indicate school (job fair location) and date (mm/dd/yy):
IBM Roadshow Indicate venue and date (mm/dd/yy):
Team Blue Ace Indicate further details, as available:

OTHER (please select specific source below and provide details)

Recruiters Database/Network Name of IBM Recruitment team member:

Offsite Recruitment Events Indicate Event Title, Venue & Date (mm/dd/yy):
Walk-In Indicate date of walk-in (mm/dd/yy) and location:

AUTHORIZED VALIDATION
Sourcing Leader Remarks:
Name/Signature:
Location/Date:

REC_PH_FRM_2015-005_v1.1 IBM Confidential Page 1 of 2

 Philippines Recruitment

DOCUMENT NO.: REC_PH_FRM_2015-005_v1.1 VERSION NO. 1.1

EFFECTIVE DATE 07/13/2015
DOCUMENT NAME: Application Source Form PAGES 1

REC_PH_FRM_2015-005_v1.1 IBM Confidential Page 2 of 2