REFRESHER TRAINING APPLICATION FORM BATCH 66

Date today:*

MonthDayYear
Date
REFRESHER TRAINING APPLICATION FORM

ACCOMPLISHING THIS FORM. ONLY CORRECTLY COMPLETED FORMS WILL BE PROCESSED.
Training Program: (Choose one)

Refresher TrainingFundamental TrainingCapacity Development TrainingSupervisory and Managerial Training
Certificate in: (Choose One)*

Commercial Train DrivingNon-Commercial Train DrivingPassenger ManagementFare and Ticketing ManagementRolling Stock MaintenanceTracks and Guideways MaintenancePower Supply and Distribution MaintenanceSignaling and Communications MaintenanceBuildings and Facilities Maintenance
PERSONAL INFORMATION

*If applicant holds dual citizenship, include both. Write both as Citizen 1/Citizen 2 (e.g., Filipino/American). * Email Address is case-sensitive. Write the exact email address, following proper capitalization.
Surname*
First Name*
Middle Name (Please put N/A if not applicable)*
Name Extension
Citizenship*
Permanent Home Address*
Date of Birth*

MonthDayYear
Date
Sex*

MaleFemale
Blood Type*
Civil Status*

SingleMarriedSeparated/AnnulledWidowed
Contact Numer*
Email Address*
juandelacruz@gmail.com
Email Confirmation (Type again your email, then click "Verify Email", then copy and paste the code sent to your email)*
CURRENT WORK DETAILS
Company Name*
Railway Line*
Division/Department*
Job Title/Position*
Employment Status*

Permanent/RegularCasualContractualCOS/JO
Employment Start*

MonthDayYear
Date
Length of Service*
Current Duties and Responsibilities*
EDUCATIONAL BACKGROUND
Highest Educational Attainment*

ElementaryHigh SchoolVocationalCollegePostgraduate
Degree*
Name of School*
Year Graduated / Target Date of Graduation*

MonthDayYear
Date
PROFESSIONAL LICENSES

Up to five (5) licenses relevant to the certificate applied for only. Include full license name and number. (PRC-issued licenses only).

PROFESSIONAL LICENSES*

	Professional License	License Number	Date Expiration
1
2
3

TRAINING ATTENDED

Fill out with training attended relevant to the certificate applied for only. Training must be attended at most five (5) years upon application. Use a separate sheet if necessary.

TRAININGS ATTENDED*

	Date Issued	Training Title	Training Provider	Certificate Number (if any)
1
2
3
4
5

WORK EXPERIENCE

Include all work experience relevant to the certificate applied for only. Work with private companies must be included

WORK EXPERIENCE*

	Inclusive Dates (From)	Inclusive Dates (To)	Employer	Position
1
2
3
4
5
6
7

PRI TRAININGS ATTENDED: HAVE YOU ATTENDED ANY TRAININGS WITH THEINSTITUTE PREVIOUSLY (YES OR NO)? PLEASE STATE ALL TRAININGS YOU HAVE ATTENDED WITH PRI:*
DISABILITIES: Do you have a disability or learning difficulty? If yes, please indicate in the allotted space the nature of your disability/difficulty. PLEASE INDICATE THE NATURE OF YOUR DISABILITY:*

YesNo
Please indicate the nature of your disability:*
FOOD ALLERGIES/PREFERENCES: PLEASE INDICATE ALL ALLERGIES/PERSONAL PREFERENCES YOU MAY HAVE: Write N/A if not applicable.*
Upload any Valid/Government ID*

Cancelof
Upload 1x1 Picture (Kindly upload your 1x1 formal and proper photo covering the frame) [This photo willbe utilized in the whole conduct of training & graduation]*
CONFIRMATION

I hereby certify that the above information/statements are true and correct to the best of my knowledge. I understand that a false information/statement may disqualify me for certification with the PRI. I acknowledge that the PRI shall use the above information for training purposes and data analysis pursuant to the Data Privacy Act of 2012. I also understand that said information will not be used for any purpose other than those set by the PRI.
Full Name (First Name, Middle Initial, Surname)*
(Ex. Juan M. Dela Cruz)
Date today:*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

REFRESHER TRAINING APPLICATION FORM

PERSONAL INFORMATION

CURRENT WORK DETAILS

EDUCATIONAL BACKGROUND

PROFESSIONAL LICENSES

TRAINING ATTENDED

WORK EXPERIENCE

CONFIRMATION