REPUBLIC OF THE PHILIPPINES

CITY GOVERNMENT OF MAKATI

PUBLIC EMPLOYMENT SERVICE OFFICE

GOVERNMENT INTERNSHIP PROGRAM (GIP)

APPLICATION FORM

Control No.: __________________

SURNAME FIRST NAME MIDDLE NAME PWD? (YES/NO):________
IF YES WHAT TYPE OF DISABILTY?

DATE OF BIRTH:(mm/dd/yyyy) PLACE OF BIRTH: 4PS(YES/NO):

AGE: Passport Size Picture

CONTACT DETAILS/CELPHONE NO.: EMAIL ADDRESS: (3.5cm x 4.5 cm)

SOCIAL MEDIA ACCOUNT ACTIVELY LOOKING FOR WORK (YES / NO)?

(FACEBOOK, TWITTER, INSTAGRAM, ETC.)

STATUS SEX  Student  ALS student

 Single  Married  Widow/er  Separated  Male  Female  out-of-school (OSY)
CURRENT STATUS OF PARENTS:  Living together  Solo Parent  Separated  Person With Disability  Senior Citizen
 Sugar Plantation Worker  Indigenous People  Displaced Worker (1)  Local (2)  OFW
PRESENT ADDRESS:

PERMANENT ADDRESS:

FATHER’S NAME /CONTACT NO.: MOTHER’S MAIDEN NAME/CONTACT NO.:

OCCUPATION: OCCUPATION:

EDUCATION NAME OF SCHOOL DEGREE EARNED/COURSE YEAR/LEVEL DATE OF ATTENDANCE

Elementary
Secondary
Tertiary
Tech-Voc
DOCUMENTARY REQUIREMENTS:
(Original and other documents, when applicable, should be presented for validation)
[ ] 1) Duly accomplished GIP Application Form.
[ ] 2) Passport Size (3.5 cm x 4.5 cm) ID picture (1 pc., white background, attach to GIP Application Form)
[ ] 3) Birth Certificate (Photocopy, PSA / NSO Copy Only)
[ ] 4) VOTERS ID/ CERTIFICATION (latest issued by COMELEC 2018-2019)
[ ] a) For Applicants aged 18-20 years old – Applicant or Parents Voters ID / Certification
[ ] b) For Applicants aged 21-30 years old – Applicant Voters ID / Certification
Voters Stub will not be honored.
Voters / Certification of Guardians will not be honored except if both parents are deceased.

[ ] 7) Long Brown Envelope (Labelled with GIP, Name, Address, Contact Number, Signature)

[ ] QUALIFIED EVALUATED BY:

[ ] DISQUALIFIED
REMARKS: DATE:
SPECIAL SKILLS:

HISTORY of GIP and SPES Availment YEAR BRGY/OFFICE ASSIGNED

st
[ ] 1 Availment
nd
[ ] 2 Availment-
rd
[ ] 3 Availment
[ ] 4thAvailment

I hereby attest that the information above are true and correct to the best of my knowledge, including the attached documents /
requirements which I also attest as to their veracity. I agree that any false statement would cause the automatic disqualification/ cancellation
of the service/ contract/ grant and I shall refund amount received and/or pay damages to the City Government of Makati or comply with other
sanctions in accordance with law. Further, I am freely giving, specific, informed indication of my will and full consent for the collection and
processing of my personal information in accordance with Data Privacy Act of 2012.
____________________________________
Printed Name and Signature of Applicant