Republic of the Philippines
Department of Education
Region VII
SCHOOLS DIVISION OF GUIHULNGAN CITY
BACKGROUND INVESTIGATION FORM
For Applicant’s Behavioral and Work Ethic
Part I. This part shall be filled up by the applicant during the Orientation of Applicants and
will be included in his/her application documents.
Name of applicant
(FN) (MN) (LN)
Position applied for
Job Description/Summary
of Position Applied For
( ) Employed
If employed: ( ) Government ( ) Private
Current Work Status: Current Position: __________________________________
( ) Self Employed
( ) Not employed
Office Name: _____________________________________________
Address: _________________________________________________
If currently employed Contact Information: _____________________________________
Name of Immediate Head: ________________________________
Position of Immediate Head: ______________________________
Type of Business: ________________________________________
If currently self-employed Office Name (if applicable): _______________________________
Address: _________________________________________________
Name: ____________________________________________________
Address: __________________________________________________
Contact Info: ______________________________________________
Name: ____________________________________________________
References (Preferably in
Address: __________________________________________________
the Personal Data Sheet)
Contact Info: ______________________________________________
Name: ____________________________________________________
Address: __________________________________________________
Contact Info: ______________________________________________
Sa DepEd Guihulngan, ang edukasyong dekalidad, malipayon namong ialagad. Dan-ag DepED Guihulngan!
Address: Osmeña Avenue, Poblacion, City of Guihulngan, Negros Oriental
Telephone No.: (035) 410-4066; (035) 410-4069 loc 206
Republic of the Philippines
Department of Education
Region VII
SCHOOLS DIVISION OF GUIHULNGAN CITY
Part II. This part shall be filled by the reference person or the assigned Office personnel to
interview the reference person.
This call/interview will be recorded for data filing purposes and all personal information disclosed shall
be considered confidential and will be strictly used only for the purpose of assessing the application of
Mr/Ms.____________________________. Further, all information will be kept in accordance with the Data
Privacy Law.
Name of Person Interviewed
School/Office/Company and
Address and Contact Info
( ) by consanguinity, pls specify ___________________________
Relationship to the applicant ( ) by affinity, pls specify __________________________________
( ) Not related
( ) Superior
Work Relationship with the ( ) Co worker
Applicant (if applicable) ( ) Subordinate
Duration the applicant is/was
under your supervision / as
superior /co-worker
Position/job title that
applicant is /was occupying in
your company
Applicant’s main responsibilities
in the company
Applicant’s outstanding
accomplishments, recognitions
or citations received, and
significant contributions
Challenges or difficulties of the
applicant in performing his/her
duties and responsibilities in
his/her position
Strength/s of the Applicant
Sa DepEd Guihulngan, ang edukasyong dekalidad, malipayon namong ialagad. Dan-ag DepED Guihulngan!
Address: Osmeña Avenue, Poblacion, City of Guihulngan, Negros Oriental
Telephone No.: (035) 410-4066; (035) 410-4069 loc 206
Republic of the Philippines
Department of Education
Region VII
SCHOOLS DIVISION OF GUIHULNGAN CITY
May we know if the applicant YES NO
COMMENTS
had issues with following: (/) (/)
1 Frequent Tardiness/
Undertime
2. Frequent Absences/Leave
without pay
3. Attendance /Participation to
programs or activities in the
company
4. Physical, mental and/or
emotional health
5. Habits or vices (i.e. gambling,
smoking, drug/substance
use)
6. Finances/Loans
7. Membership in groups/
unions/ association with
questionable reputation
8. May we know if the applicant
YES NO
had issues on and how did COMMENTS
(/) (/)
he/she relate with his/her:
1. Superiors
2. Peers
3. Subordinate
9. Does the applicant have a
pending or past record of
disciplinary action or grievance
filed against him/her or other
complaints settled in the
school/office/barangay level?
(Applicant is the person
complained of)
13. Does the applicant have a
pending/settled complaints
/grievance against a co-teacher,
school or division personnel, etc.
or complaints filed in barangay
or regular courts (Applicant is
the complainant)
Sa DepEd Guihulngan, ang edukasyong dekalidad, malipayon namong ialagad. Dan-ag DepED Guihulngan!
Address: Osmeña Avenue, Poblacion, City of Guihulngan, Negros Oriental
Telephone No.: (035) 410-4066; (035) 410-4069 loc 206
Republic of the Philippines
Department of Education
Region VII
SCHOOLS DIVISION OF GUIHULNGAN CITY
YES NO
COMMENTS
(/) (/)
14. Is the applicant willing to
work outside his/her official
duties and responsibilities and
willing to work beyond the official
hours?
15. Use the following rating guide, 1 being the lowest and 5 being the highest.
Rating Guide 5 4 3 2 1
Minimal Much
Please check (/) the appropriate Shows Very
Proficient development development
box strength proficient
needed needed
Complies to policies, rules, and
other standards set by the
office/company
Responds effectively /
immediately to the guidelines /
feedback on one’s performance,
well-being and learning
discipline
Take initiative and provides
solutions within the limits of the
available resources such as time
and money in relation to the
problems encountered in school.
Demonstrates the ability and
knowledge to formulate ideas,
make plans and use variety of
techniques to achieve the set
goals and objectives.
Ability to interact, work, relate
effectively to his/her co-
teachers, superior and other
school personnel.
Demonstrates the ability to take
the lead and communicate with
his/her co-employees ensuring
the group acts in a unified
workforce.
Ability to motivate his/her
colleagues to aid in achieving
school goals and objectives.
Efficient in his/her work
(Was he/she able to deliver the
task expected of him/her with
maximum productivity and
minimum wasted effort or
expense; achieving maximum
productivity with minimum
wasted effort or expense)
Sa DepEd Guihulngan, ang edukasyong dekalidad, malipayon namong ialagad. Dan-ag DepED Guihulngan!
Address: Osmeña Avenue, Poblacion, City of Guihulngan, Negros Oriental
Telephone No.: (035) 410-4066; (035) 410-4069 loc 206
Republic of the Philippines
Department of Education
Region VII
SCHOOLS DIVISION OF GUIHULNGAN CITY
Would you recommend the
applicant to this position?
I attest to the truthfulness and veracity of the foregoing information to the best of my
knowledge and without any mental reservation.
_________________________________________
Name and Signature of the Respondent/
Person Interviewed
_______________________
Date
Thank you for your time and assistance in providing us these information. Rest
assured this shall be treated with confidence by our agency.
RACHEL L. CHIONG
Administrative Officer IV
Human Resource Management Officer
Name and Signature of the DepEd Personnel
Who Conducted BI
_______________
Date
Enclosure (if applicable) File name of the recorded audio:
Sa DepEd Guihulngan, ang edukasyong dekalidad, malipayon namong ialagad. Dan-ag DepED Guihulngan!
Address: Osmeña Avenue, Poblacion, City of Guihulngan, Negros Oriental
Telephone No.: (035) 410-4066; (035) 410-4069 loc 206
