ADSWI Membership form

ASSOCIATION OF DSWD SOCIAL WORKERS, INC.

DSWD Central Office Chapter

Constitution Hills, Batasan Complex, Quezon City

MEMBERSHIP APPLICATION FORM

The undersigned hereby subscribe to the vision, mission and goals being promoted and advocated by the Association of DSWD Social Workers (ADSWI) and will hereby abide by its policies, rules and regulations.

A.     Profile:

Name	Age	Sex
Civil Status	Office contact No. (Telephone)	Cell phone No.
Email Address	Permanent Address	Birthplace
Date of Birth	Highest Educational Attainment	Occupation/Position
Office	Date Employed	Status of Employment
Name of Spouse	Occupation	Age
Name of Dependents	Age	Occupation

B.     Professional Advancement for the last five years:

Training/Seminars related to Social Work Profession and Work Assignment	Sponsored/Conducted by	No. of hours	Month & Year

C.     Opportunities/Incentives availed/received for the last five years:

Scholarship grants/awards	Sponsored/Awarded by:		Duration of Scholarship

D.    Recognitions:

Title	Awarded by:		Date conferred

E.      Other Professional Membership:

Name of Organization	Position	Date of membership	Benefits received

F.      Personal feelings & opinion:

What can you say about your current work or assignment?

_________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Is your work/tasks aligned with your competencies as a social worker? Yes/No. Please explain your answer.

_________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are you satisfied with the present benefits and privileges for social workers provided by the Department? Yes/No. Kindly explain your answer.

_________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you ever been convicted of any crime? (e.g. administrative).  If in the affirmative, pls. explain

_________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How can ADSWI help you:

1. As a social worker?

___________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

2. As a DSWD employee?

___________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

Please choose one committee in the organization where you are willing to contribute your knowledge/attitude/skills/expertise

1. Membership and Resource generation
2. Education and Capability Building
3. Advocacy and Networking

I HEREBY CERTIFY that the above information is true and correct to the best of my knowledge and belief.  Signed this _______ day of _______________________________ 2012 at __________________,

                                                                                    _________________________________

                                                                                               Applicant’s Signature

Approved by:

_________________________________________________________

Chair, Membership and Resource Mobilization Committee

Concurred by:

_________________________________________________________

President, ADSWI

Documents needed to support the membership form: (Xerox only)	Available (Yes/No)
·         Valid DSWD ID
·         Valid PRC ID
·         Appointment/MOA/Contract
·         PASWI ID (if available)
·         Membership Payment (P500.00)

(Note: You may submit this membership form to the Treasurer of ADSWI DSWD Central Office and Field Office)