8/21/2019 Poe Form
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DECLARATION:
1. Have you taken the Career Service Examination before?
YES [ ] NO [ ] If NO, please proceed to succeeding
questions.
If YES, you are disqualified to take the Career Service
Examination
at this time. You may take the same level of the CSE after
three (3) months.
2. Have you failed the same level of examination for four (4)
times or more?
YES [ ] NO [ ] If NO, please proceed to succeeding questions. If
YES, have two (2) years already lapsed from the date the fourth
(4th) failed examination wa
If YES, you are qualified to apply for the same level of the CSE
and mayto the succeeding questions.
If NO, you are disqualif ied to apply for the same level of the
CSE at this
You may apply for the same level of the CSE only after two (2)
ye
from the date of the fourth (4th) failed examination taken.
3. How many times have you taken the Career Service Examination
starting October 7, 2002?
Professional Dates of Exam: ____________ _____
____________ _____
Subprofessional Dates of Exam: ____________ _____
____________ _____
4. Reasons for taking the Career Service Examination:
__________________________________________________
5. Have you attended review classes in preparation for the
examination? ____________________________________
If YES , what Review Center?
_____________________________________________________________________
Done this __________ day of _______________________,
20_______.
APPLICANT
(Signature over Printed Name)
IMPORTANT BRING THE FOLLOWING ON EXAMINATIO
1. This Application Receipt
2. One [1] blue or black ballpen
IF YOU FAIL TO RECEIVE YOUR NOTICE OF ASSIGNMENT FIVE [5] 3.
Lead pencil/s no. 2 and eraser/s
DAYS BEFORE THE EXAMINATION, PLEASE VISIT OR CALL THE 4. Valid
I.D. Card with photo, signature, birth
REGIONAL OFFICE WHERE YOU FILED YOUR APPLICATION TO INQUIRE
available), and signature of authorized head of
ABOUT YOUR SCHOOL ASSIGNMENT. FOR NCR APPLICANTS, PLEASE
(Office/School/Postal ID/Passport/License/BIR
VISIT OUR WEBSITE: www.csc.gov.ph. FAILURE TO COME ON YOUR *
This should be the same as that prese
SCHEDULED EXAMINATION WILL MEAN FORFEITURE OF EXAMINATION the
time of application.
FEE AND SLOT. * NO I.D., NO EXAM.
* DO NOT bring cellular phones & other materi
of those above-listed, otherwise , they will beby the Security
Officers. The Commission will n
for the loss or damage of said belongings.
once 2x 3x 4x more than 4x
I declare that the abovementioned information are true. I
understand that the acceptance and approval of my application for
the examination i
the abovecited declaration.
I therefore agree that, in case a post-verification yield
information contrary to what is declared, my application shall be
disapproved and my pa
forfeited.
In addition, I agree that any misrepresentation made in this
document may cause the invalidation of the result of this
examination and/or the filadministrative/criminal case/s against
me.
8/21/2019 Poe Form
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CS FORM No. 100 (Revised 2008) Republic of the PhilippinesTHIS
FORM IS NOT FOR SALE CIVIL SERVICE COMMISSIONREPRODUCTION IS
ALLOWED Region: _________________ APPLICATION NO. __
DATE LAST TAKEN:
( mm / dd / yyyy ) For Proc
DATE OF EXAM: ( mm / dd / yyyy )
PLACE OF EXAM:
1. APPLICANT'S NAME (PRINT IN CAPITAL LETTERS)
__________________ __________________________ ________
_____________________ ________ 2. AGE:__ (LAST NAME) (FIRST NAME)
(Name Extension, e.g. Jr. , Sr., I II ) (MIDDLE NAME) (MI)
3. APPLICANT'S MAIDEN NAME: _________________________
__________________________ _____________ (For Married Women) (FIRST
NAME) (MIDDLE NAME) (LAST NA
4.COMPLETE MAILING ADDRESS Tel. No:_______________ Cell.
No:______________
__________________________________________________________________________________
Zip Code
5. CIVIL STATUS:_________6. SEX: Male Female 7.HEIGHT(m.)
__________ 8. WEIGHT(kg) _______
9.BIRTHDATE: 10. BIRTHPLACE : _________________________ 11.
CITIZENSHIP:__ ( yyyy mm dd ) (City / Town / Province)
12. HIGHEST EDUCATIONAL ATTAINMENT:
Level of If not graduated,Education Highest Grade/Year/
Honors
Level/Units Earned
13. PRESENT EMPLOYMENT Government Private None
AGENCY/OFFICE ADDRESS RANKSTATUS OF A
14. CIVIL SERVICE/BOARD/BAR/EXAMINATIONS PASSED(Use separate
sheet if necess ary)
Rating Place of Exami
15. Have you ever been dismissed from the service for cause, or
found guilty of crime involving moral turpitude, or of infamous,
dis
immoral conduct, drunkenness or addiction to drugs, or of
offense relative to or in connection with the conduct of a c
examination? YES [ ] NO [ ] If YES , attach copy/ies of
decisions.
16. Have you already passed the same level of examination being
applied for? YES [ ] NO [ ]
I dec lare under oath that I persona lly accompl ished th is app
l icat ion form, and I hereby cer ti f y that the in formation g
iv
t rue, cor rec t and co mple te s ta tements pursuant to the
prov is ions of per t inent laws, ru les and regu lat ions of the
Repu
the Phi l ippines.
I l i kew ise ag ree that I w i l l sub jec t myse lf t o a va
li dat ing exam inat i on in case the tes t resu lt s in my p lace
o f exam in
stat is t ical ly improbable.
_______________________ Signature of Applicant
Right Thumbmark
Subscribed and sworn to before me this ________ day of
__________________ 20 _______.
OFFICE/POSITION
( Do not f i l l -up this port ion. For Processor/s only )
ACTION TAKEN: APPROVED [ ] DISAPPROVED [ ] DATE _____________
_________________________
Printed Name and Signature of
A P P L I C A T I O N R E C E I P T Application No.
_____________
Received the application for the: PENOLOGY OFFICER
EXAMINATION
TIME: ______________ Printed Name of Processor:
_________________________
: _________________ gnature o rocessor:
________________________PLACE: ___________________________ Date
Received/Processed: _________________
Applicant's Printed Name:
_____________________________________________________
Birthdate: ________________________________ Sex:
_________________________
Signature:
_______________________________________________________________________
ADMINISTERING OFFICER (Signature above Printed Name)
WARNING: Impersonation, cheating and other forms of examination
irregularity would lead to dismissal from govern
____________ service, perpetual bar from taking civil service
examinations, disqualification for re-employment in the
____________ government, and/or imprisonment/fine
Course/Degree
- Please see Back Page for Other Important Exam ination
Information -
Ac
Date of
Examination
TO
Inclusive YearsOf Attendance
FROM
PENOLOGY OFFICER EXAMINATION
TITLE OF EXAMINATION APPLIED FOR[READ THE EXAMINATION
ANNOUNCEMENT. DO NOT APPLY IF YOU
ARE NOT QUALIFIED]
(Write in full)
Graduated not Graduated
TITLE OF EXAMINATION LAST TAKEN
LENGTH OF EXPERIENCE IN
PRESENT RANK
Name of School Attended andAddress
Email add:_____
Date:________________________________
O.R.No.________________________
_____
Amount________________________
_____
______________________________________
PrintedNameandSignatureofCollectingOfficer
D
ate:________________________________
O
.R.No._____________________________
A
mount_____________________________
_
______________________________________
PrintedNameandSignatureofCollectingOfficer
4Passport size (1.photo taken withi3 months with F
Nametag4Scanned, compu generated/enhan
photocopied, cutpictures withoutare not accepted
4Passport size (1.photo taken withi3 months with F
Nametag4Scanned, comp generated/enhan
photocopied, cutpictures withoutare not accepted
