POEA DOLE OWWA

BAGONG BAYANI AWARDS

Official Nomination Form

CATEGORY (Please Check & Specify)

Land-Based
_______________________ Professional, Technical and related worker
_______________________ Executive and Managerial Worker
_______________________ Production Process Worker, Transport Equipment
_______________________ Operator and Laborer
_______________________ Clerical and Sales Worker
_______________________ Service Worker
_______________________ Overseas Performing Artist
Sea-Based
_______________________ Seaman (Officer)
_______________________ Seaman (Ratings)

A. PERSONAL DATA OF NOMINEE

1. Name _________________________________________________________________________
(Family Name) (Given Name) (Middle Name)
2. Age _______________ 3. Sex __________________ 4. Civil Status _____________________
5. City Address ____________________________________________________________________
6. Philippine Address _______________________________________________________________
7. Jobsite Address _________________________________________________________________
8. Telephone Number/s _____________________________________________________________
9. Date of Birth _____________________ 10. Place of Birth ______________________________
11. If Married:
Name of Spouse (Maiden Name) ____________________________________________________
Address ____________________________________________ No. of Children _______________
If employed: Position _________________________Name of Employer______________________
12. Name of Parents: Mother: ______________________ Father: _____________________________
B. EDUCATIONAL BACKGROUND
EDUCATIONAL NAME & 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 _________________________________________________________________
Address _________________________________________________________________________
Length of Service in present job _________________ Location/Name of Project: _______________
Name of Local Agency/Entity thru which nominee was hired, if any: ___________________________
2. 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
___________________________ _________________________ ___________________________
___________________________ _________________________ ___________________________
___________________________ _________________________ ___________________________
3. Promotion/s in work while an overseas worker.
PREVIOUS POSITION POSITION PROMOTED DATE COMPANY/EMPLOYER
TO
_____________________ ____________________ ________ _______________________
___________________ __________________ _______ _____________________
___________________ __________________ _______ _____________________

4. Participation in Community Activities (abroad)

ORGANIZATION POSITION OR NATURE OF INVOLVEMENT
_____________________________________ _____________________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________

5. Participation in Community Activities (Philippines)

ORGANIZATION POSITION OR NATURE OF INVOLVEMENT
____________________________________
_____________________________________
____________________________________
_____________________________________
_________________________________ _________________________________

_______________________________
Signature of Nominator

________________________________
Name of Nominator

ADDRESS OF NOMINATOR: __________________________________________________________________

TELEPHONE NUMBER ______________________________________________________________________

One (1) copy duly accomplished (with supporting documents) to be sent to:

1. BBA Secretariat 2. In the concerned Philippine Overseas Labor Office (POLO)

Welfare & Employment Office
2nd Floor, BFO Bldg., Ortigas Avenue
cor. EDSA, Mandaluyong City
Fax no. (632) 724-3646
Email: bagong_bayani_awards@yahoo.com