Republic of the Philippines

Paste a recent 1x
Department of Health 1 photograph
(taken within the
DEPLOYMENT PROGRAM/ PROJECT last 6 months) in
this box.
APPLICATION FORM
Print legibly and use separate sheet if necessary. Place marks in appropriate boxes. Only accomplished applications will be processed.
POSITION APPLIED FOR:
Doctors to the Barrios Program (DTTB) Dentist Deployment Project (DDP)
Physician/ UHC Implementers Medical Technologist Deployment Project (MTDP)
Nurse Deployment Project (NDP) Public Health Associates Deployment Project (PHADP)
Rural Health Midwives Placement Program (RHMPP)

Personal Background
Name
CORONG DAVE ANGELO DELA CRUZ
Surname First Name Middle Name
Date of Birth (mm/dd/yyyy) Place of Birth Dialect/s Spoken

March 24, 1991 Romblon, Romblon English, Tagalog, Bisaya

Age Gender Civil Status Nationality Religion
[] Female [] Single[ ] Widowed
25 y/o [ ] Male [ ] Married [ ] Separated Filipino Born Again

Permanent Address Tel. #. / Mobile Number/s

09398170937/09165916175
Interior Capaclan ROMBLON, ROMBLON ROMBLON Email Address
Street District Municipality/City Province dave_rbc205@yahoo.com

Educational Background
School Attended Inclusive Dates Honor(s) / Distinction Received/Papers made or Published

Primary
Romblon East Central School 1997-2003
Secondary
Romblon National High School 2003-2007
Tertiary (Degree Earned)
Arellano University-Main 2007-2011
Bachelor of Science in Nursing
Post Graduate

Eligibility
DATE OF EXAMINATION/
CAREES SERVICE / R.A. 1080 LICENSE (if applicable)
RATING CONFERMENT PLACE OF EXAMINATION/
(BOARD/BAR) UNDER SPECIAL CONFERMENT
LAWS/CES/CSEE
NUMBER REGISTRATION
DATE

Nurse Licensure Examination 75 Dec.16&17, 2012 University of the East 0736709 2-28-2012

Employment Background
Position Title Office/Company Inclusive Dates Status of Employment
Nurse 1- Nurse Deployment Program Department of Health January 2014 to Present Employed
Review Assistant Professional Review Network June 30 to December 2014 Part-time
Private Nurse/Home Care Nurse Home Health Care Clinic June 30 to March 15, 2013 On-call/Part-time
(continue on separate sheet if necessary)
Community Involvement
Organization/Association Type of Involvement Inclusive Dates Status of Involvement

(continue on separate sheet if necessary)

Trainings Attended (Start from the most recent training within 5 years.
Inclusive Dates of Attendance Number of
Title of Seminar/Conference/Workshop/Short Courses Conducted / Sponsored by
(mm/dd/yyyy) Hours
(Write in Full) (Write in Full)
FROM TO
Interpersonal Communication & Counseling Training Nov. 23, 2015 Nov. 26, 2015 72 hrs. Department of Health Regional Office IV-B
Basic Life Support Training Feb. 19, 2015 Feb. 20, 2015 48 hrs. Rural Health Unit Romblon
Training of Trainers for Barangay Health Leadership and
Aug. 18, 2014 Aug. 20, 2014 72 hrs. Department of Health Regional Office IV-B
Management Workshop
(continue on separate sheet if necessary)
I declare that all information and documents submitted with this application form is true and correct. I authorize the agency head or its authorized representative to verify /
validate the contents stated herein. I trust that this information shall remain confidential.

Dave Angelo Corong, R.N November 29, 2016

Signature over Printed Name Date
DOH-HHRDB, Deployment Program/ Project
Application Form
Revision 0
Series 2015
THIS FORM IS FREE OF CHARGE AND MAY BE PHOTOCOPIED
DOH-HHRDB, Deployment Program/ Project
Application Form
Revision 0
Series 2015
THIS FORM IS FREE OF CHARGE AND MAY BE PHOTOCOPIED