HRD-FO-005 - Applicants Information Sheet - Rev3. As of 4.19.24.for Printing

Document Code HRD-FO-005
Revision 03
Effectivity Date 2024/04/19
HUMAN RESOURCE DEVELOPMENT OFFICE Page/s Page 1 of 3
APPLICANT’S INFORMATION SHEET

This document and the information provided here is treated in confidence between you and the University. This is
for the sole purpose of the employment selection process. This cannot be disclosed to any third party or be used for any
other purpose.
1. POSITION APPLIED FOR: SCIENCE/ CHEMISTRY TEACHER
2. PERSONAL INFORMATION
NAME: _______________BUGTONG____________ HENNO NICKOLE VINCE___ AMBROS________

Family Name Given Name Middle Name
Home 45 BANGAN HILL BRGY. VISTA ALEGRE , BAYOMBONG , NUEVA VIZCAYA Tel. No./Mobile No.:
Address: 09352441581
Bayombong Address:45 BANGAN HILL BRGY. VISTA ALEGRE , BAYOMBONG , NUEVA VIZCAYA
Email Add.: hennonick@gmail.com
Date of NOVEMBER 15,1999______ Age: 24 Place of Birth: BAYOMBONG , NUEVA VIZCAYA
Birth:
Father’s Name: NICKANOR V. BUGTONG Age: 55 Occupation: FRAMESHOP OWNER
Mother’s Name: RANSEVERE MARY A. BUGTONG Age: 57 Occupation: HOUSEWIFE
Current Church Affiliation/Religion: ROMAN CATHOLIC Confirmed? Yes ___/___ No _________
Civil __/__Single ____Married Name of Spouse:__________N/A_______________ Occupation of Spouse:
Status: ________N/A_________
Church of __________________N/A_______________________ Date__N/A_______ No. of
Marriage: Children:__N/A_____________
Place of Marriage: ___________________N/A________________________________________________
Are you in a live-in relationship? ____Yes ____NO If yes, please explain: ______________ N/A________________________
3. EDUCATIONAL PREPARATION
a. Grade School/Secondary Education
Month & Year of
School Address
Graduation
Grade School Bayombong South Elementary School Bayombong, Nueva Vizcaya June 2012
Junior High School NVGCHS Bayombong, Nueva Vizcaya April 2016
Senior High School NVGCHS Bayombong, Nueva Vizcaya April 2018
b. Bachelor’s Degree/Vocational Course

Month & Year of
Degree Major/Minor School and Address
Graduation
Bachelor of Secondary General Science Saint Mary’s University- Bayombong July 2022
Education
Honors Received: ACADEMIC DISTINCTION
c. Masters/Doctorate Degrees
Month & Year of
Graduation
Degree Major/Minor School and Address
(No. of units earned if
studies is ongoing)
Master of Arts in Education General Science NVSU- Bayombong Campus 9 units
Honors Received:
4. PROFESSIONAL BOARD/BAR EXAMINATIONS

Examination/s Taken Date Passed Rating
August Civil Service Examination 11/03/23 84.04
Revision 03
Licensure Examination for Teacher 12/07/23 87.40
5. WORK EXPOSURES AND EXPERIENCES

a. Teaching Experience
Inclusive Full-time/ Reason for
Position/s Held Institution Address Contact No. Dates Part Time Leaving
(month & year)
Classroom Saint Joseph School Kiangan, Ifugao N/A Aug 2022- Fulltime Ready for Boards
Teacher May 2023
b. Professional Experience/Others
Contact Inclusive Full-time/ Reason for

Position/s Held Institution Address Dates
No. Part Time Leaving
(month & year)
6. Has there been any complaint (civil, legal, barangay, etc.) brought out or filed against you?
Yes ______ No __/___
If yes, please explain: ___________________________________________________________________________________________________________
7. May we Contact Your Present / Previous Employer and / or Character References for information
verification?
Yes ______ No __/____
8. AFFILIATIONS/MEMBERSHIP TO PROFESSIONAL ORGANIZATIONS

Name of Organization Position Held Inclusive Dates
N/A
9. RELATIVES EMPLOYED IN SMU (parents, children, brother, sister, uncle, aunt, cousins)
Name Position Held Office/Department Relationship
N/A
10. CHARACTER REFERENCES (Please do not include any of the hiring authorities of this Institution)
Name Position Held Agency/Institution Address and Contact No.
Nicole Shayne A. Palparan Local Government LGU Bayombong Magsaysay, Bayombong, Nueva
Employee Vizcaya
09755652257
Elton Jay V. Tabuyo Accountant N/A Bayombong, Nueva Vizcaya
09277052690
Sharmaine Salaber Audit Associate SGV Ayala, Makati Makati City
Revision 03
09292127887
I certify that all information contained in this application is true and complete. I understand that false
information may be grounds for not hiring me or for immediate termination of employment at any point in the future if
I am hired. I authorize the verification of any or all information listed above.
Accomplished on ________May 7,2024__________ ______HENNO NICKOLE VINCE A. BUGTONG______

Date Signature over Printed Name
*Where did you learn about the vacancy?

__/_ FB post _____ SMU Website ______Job Fair
____ Radio Ads _____ From a friend ______Walk-in
____ TV Ads _____ SMU Employee

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Document Code HRD-FO-005

APPLICANT’S INFORMATION SHEET

NAME: _____BUGTONG HENNO NICKOLE VINCE_ AMBROS________

b. Bachelor’s Degree/Vocational Course

Honors Received: ACADEMIC DISTINCTION

4. PROFESSIONAL BOARD/BAR EXAMINATIONS

Licensure Examination for Teacher 12/07/23 87.40

5. WORK EXPOSURES AND EXPERIENCES

Contact Inclusive Full-time/ Reason for

8. AFFILIATIONS/MEMBERSHIP TO PROFESSIONAL ORGANIZATIONS

Accomplished on May 7,2024 HENNO NICKOLE VINCE A. BUGTONG__

*Where did you learn about the vacancy?

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