REQUESTING PERSONNEL'S SURNAME

REQUESTING PERSONNEL'S FIRST NAME

NAME EXT. (Jr.,Sr.)

REQUESTING PERSONNEL'S MIDDLE NAME

UNIT/COLLEGE

REQUESTING PERSONNEL'S EMAIL

For Separated/Retired Employeed, please indicate address and contact number

DOCUMENT TO BE REQUESTED (Please select)

Service Record
Certification as to Employment
Certification for VISA Application
Certification as to Travel Abroad
Others, please specify.

PURPOSE

AUTHORIZED PERSONNEL (if any)

CONSENT AGREEMENT
Data Collection and Purpose
I voluntarily agree to allow Bicol University HRMDO to collect, use, and process my personal data, including my first name, middle name, last name, name extension, and email address, for the purposes specified in this form, including but not limited to records requests and HR-related activities.
Rights Under the Data Privacy Act
I acknowledge that I have been informed of my rights under the Data Privacy Act of 2012, which include the right to access, correct, and withdraw consent to my personal data at any time, subject to legal and regulatory requirements.
Retention of Data
I understand that Bicol University HRMDO will retain my personal data for as long as necessary to fulfill the purposes outlined in this form and comply with legal and regulatory requirements.
Confirmation of Consent
By submitting this form, I confirm that I have read, understood, and voluntarily agree to the terms outlined in this consent form.

Yes, I confirm