REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. III
PUBLIC EMPLOYMENT SERVICE OFFICE
_____________________________________________________________
City/Municipality/Province

SPECIAL PROGRAM FOR EMPLOYMENT OF STUDENTS (SPES)

(RA 7323, as amended by RAs 9547 and 10917)

APPLICATION FORM Control No.:

SURNAME FIRST NAME MIDDLE NAME GSIS BENEFICIARY/RELATIONSHIP

DATE OF BIRTH: (mm/dd/yyyy) PLACE OF BIRTH: CITIZENSHIP:

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

SOCIAL MEDIA ACCOUNT (FACEBOOK, TWITTER, INSTAGRAM, ETC.)

STATUS SEX  Student  ALS Student

 Single  Married  Widow/er  Separated  Male  Female  Out-of-School Youth (OSY)
PRESENT ADDRESS:
PERMANENT ADDRESS:
FATHER’S NAME /CONTACT NO.: MOTHER’S MAIDEN NAME/CONTACT NO.:

OCCUPATION: OCCUPATION:

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
EDUCATION NAME OF SCHOOL DEGREE EARNED/COURSE YEAR/LEVEL DATE OF ATTENDANCE
Elementary
Secondary
Tertiary
Tech-Voc
Are you graduating from college / technical vocational course next school year?  Yes  No
REQUIREMENTS: 5. Two (2) photocopies of latest Income Tax Return (ITR) of both
1. 2 copies of SPES application form parents, the combined annual net income of both parents must not
2. 3pcs. Passport size pictures; exceed P139, 200.00; OR certification issued by BIR that the LIVING
3. 2 copies of photocopied Birth Certificate; parents are exempted from payment of tax. (BIR Certificate of Tax
4. 2 copies of photocopied Report of Grades (bring original REPORT OF Exemption);
GRADES for verification or duly signed by the School Registrar with name, 6. 1pc Long brown envelope (hard);
signature & dry seal.); 7. If under guardianship: 2 copies of Certificate of Guardianship from
a. For Incoming Senior High School (Grade 11 and 12): Barangay and Affidavit of Guardianship duly notarized if living with
Form 138 1st-3rd grading period (Note: AVERAGE SHOULD BE guardian(s).
80%)
8. For Solo Parent: Solo parent ID or Certification from Barangay.
b. For Incoming College, New Iskolar and Old Iskolar:
1st Sem S.Y.2018-2019 Report of Grades with General 9. Photocopy of School ID.
Weighted Average (GWA) duly signed by school registrar. 10. Parent’s Voter’s ID

SPECIAL SKILLS:
HISTORY of SPES Availment/ Name of Establishment YEAR SPES ID NO. (if applicable)
[ ] 1stAvailment
[ ] 2ndAvailment-
[ ] 3rdAvailment
[ ] 4thAvailment
Other related information/ requests/ interventions from DOLE:
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 DOLE or comply with other sanctions in accordance with law. Any material
change in my financial status may affect my eligibility to continue the program.

_________________________ ____________________________________
Date Signature of Applicant

___________________________________________
Name & Signature of Registration Officer

BLE Revision as of December 2016

Distributions: Original Copy/White – Auditor’s Copy; Duplicate Copy/Yellow – DO

LE RO/TSSD; Triplicate Copy/Green – PES