IS FORM IS FREE OF COSTPP
BIODATAApplicant: Applying For: ____________________
Name: Leslie N. Embradora
Age: 41
Date of Birth: July 15, 1977
Gender: Female Weight: 55 kls Height: 5’1”
Educational Attainment: High School Graduate
Complete Address: Blk 7 Lot 38 Deca Homes Baywalk Phase 3 Dumlog Cebu City
Telephone No: 09471194702
Passport No. EB8542263
Date of Issue: JULY 3, 2013
Place of Issue: Seoul Korea
Expiry Date: JULY 2, 2018
SSS Number: 06-26924324
PAG-IBIG Membership Number: ________________________________________________
Phil Health Number: 120251616871
Work Experience: yes ( ) No ( )

SNO.
NAME OF THE EMPLOYER
KIND OF WORK

PLACE OF WORK
DATE OF WORK
NUMBER OF MONTHS

M Lhuilier
Cashier/sales clerk
Lahug Cebu City
Feb 2, 2014
1 year and 1 month

*Start from the latest experience
Family Background:
Marital Status: Married ( ) widow ( ) Separated ( ) Single Mom ( )
Spouse Details:
Name: Novien Embradora
Age: 41 years old
Date of Birth: November 9, 1979
Telephone No. 09331332178
Educational Attainment: Marine Engineering
Complete Address: Deca Homes Baywalk Phase 3 Dumlog Talisay City Cebu
Source of Income: Zumba Instructor
_________________________________________________________________________
Number of Children: 3
School Details:
SNO.
Name of Children
Age
M/F
Place of School
Grade /Course

Queenie Kate Mahusay
18
F
Davao City
3rd Year College

Vienz Joseph Embradora
12
M
Tabunok Talisay City Cebu
Grade 7

Katrice Angel Embradora
10
F
Talisay Cebu
Grade 6

Other Dependents: (Example: Parents)
Name of Dependents
Age
M/F
Relationship

Address
Contact Number

Novien Embradora
41
M
Husband
Talisay City Cebu

OtherContact Persons:
Name
Relationship
Contact Number
Email Address

Diana Pelliren Rodimo
Friend
09059992431

Bryan Jamora
Friend
09173414657

Mmaz/2972017