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Consent & Authorization Letter

Please read and agree to the consent letter below

CONSENT AND AUTHORIZATION LETTER

TO WHOM IT MAY CONCERN:

I, [FULL NAME], of legal age and a resident of the Philippines, hereby give my consent and authorization to the following:

  1. I authorize the collection, processing, and storage of my personal data as provided in this registration form for legitimate purposes related to my employment/engagement as a Doctor.
  2. I consent to the verification of the information I have provided, including but not limited to educational background, employment history, and character references.
  3. I authorize the organization to conduct background checks as may be necessary for the evaluation of my application.
  4. I understand that my personal information will be kept confidential and will only be used for the purposes stated herein and in accordance with the Data Privacy Act of 2012 (Republic Act No. 10173).
  5. I agree that my photograph, signature, and valid ID may be used for identification and official records purposes.
  6. I acknowledge that I have provided truthful and accurate information to the best of my knowledge.

I understand that providing false information may result in the rejection of my application or termination of engagement if discovered later.

Date: November 14, 2026

Printed Name: [FULL NAME]

You must agree to proceed with the registration.

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