Bagong Bayani Awards

BAGONG BAYANI AWARDS

Official Nomination FormIn partnership with:

POEA DOLE OWWA

CATEGORY (Please Check & Specify)

Land-Based Workers

______Managers

______Professionals

______Technicians and Associate Professionals

______Clerical Support Workers

______Services and Sales Workers

______Skilled Agricultural, Forestry and Fishery Workers

______Craft and Related Trades Workers

______Plant and Machine Operators and Assemblers

______Elementary Occupations/Others

Sea-Based Workers

Traditional Merchant Marine Category

______Seafarer (Officers)

______Seafarer (Ratings)

______Seafarer (Cruise Ship)

______Seafarer (Others)

Capt. Gregorio S. Oca Award

______Individual

______Entity

A.PERSONAL DATA OF NOMINEE

1.Name ______

(Family Name)(Given Name) (Middle Name)

2.Age ______3. Sex ______4. Civil Status ______

5.Philippine Address ______

6.Address Overseas ______

7.Jobsite Address (Landbased) ______

8.Vessel Name (Seabased) ______

9.Telephone Number/s Overseas ______9. Philippines______

10.Email Address ______

11.Date of Birth ______12. Place of Birth ______

13.If Married:

Name of Spouse (Maiden Name) ______

Address ______No. of Children ______

If employed: Position ______Name of Employer______

1. Name of Parents: Mother: ______Father: ______

B.EDUCATIONAL BACKGROUND

EDUCATIONALNAME & LOCATION INCLUSIVE DATES

ATTAINMENT OF SCHOOL OF ATTENDANCE

Elementary ______

High School ______

College (Degree) ______

Others ______

Government Examination Passed: ______

C.EMPLOYMENT BACKGROUND

1.Present Position ______

Name of Employer/Principal ______

Address______

Length of Service in present job______Location/Name of Project: ______

Name of Local Agency/Entity thru which nominee was hired, if any: ______

1. Previous Employment (use additional sheets if necessary)

POSITION NAME AND ADDRESS INCLUSIVE DATE NAME OF LOCAL

OF EMPLOYER OF SERVICE AGENCY/ENTITY

THRU WHICH

NOMINEE WAS HIRED

______

______

______

D.JUSTIFICATION FOR NOMINATION

1. Cite the exemplary act (heroism, pioneering work, outstanding accomplishment, endurance in work, promotion of positive values, etc.) for which the overseas Filipino worker is nominated, including the date and other relevant background information. (Not more than 300 words. Attach supporting documents. Use separate sheet, if necessary.)

______

2. Citations, Awards or Commendations received in connection with the exemplary act of the nominee and other accomplishments. Attach photocopies of citations/awards.

NATURE DATE AND PLACE GIVEN COMPANY OR INSTITUTION

WHICH GAVE THE AWARD

______

______

______

1. Promotion/s in work while an overseas worker.

PREVIOUS POSITION POSITION PROMOTED DATE COMPANY/EMPLOYER

TO

______

______

______

1. Participation in Community Activities (abroad)

ORGANIZATION PO

SITION OR NATURE OF INVOLVEMENT

______

______

1. Participation in Community Activities (Philippines)

ORGANIZATION POSITION OR NATURE OF INVOLVEMENT

______

______

______

______

Signature of Nominator

______

Name of Nominator

ADDRESS OF NOMINATOR: ______

TELEPHONE NUMBER: ______

EMAIL ADDRESS: ______

Please provide the following: