ࡱ>  \p Licensed User Ba==%8X@"1Arial1Arial1Arial1Arial1xArial1Arial1Arial1( Book Antiqua1Arial1Arial1Arial1Arial1" Wingdings1Arial1Arial1Arial1Arial1( Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1( Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1Arial1( Arial Narrow1 Webdings1 Webdings1Arial1( Arial Narrow1( Arial Narrow1( Arial Narrow1Arial1Arial1Arial1Arial1Arial1Arial1( Arial Narrow1Arial1 <Webdings1(  Arial Narrow"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                + ) , *   h  x &x &x  &x &x  h   h  h   h  h !x  "x  !x  &x  &x  "x@  "x  &x  &x@  &x  h@@  h x@@  &x@  &x @ x@  h@ &x@ &x @  h @   h  h  h &x  h   h@ &x  h  !x  h "x  "x@  h   h@    h@   (  (@    &x  (f@@    h@@ x @  "x@  ( !x )0  "x  "x@@  *x !x   hf@   (`f @   (@   ( "x  (  "x  h@@ &x@@ &x@  h@  "x@  (f@  (`f @  (    (`  (  (@  !8  (`@  (`  (``  h`f @   h@@   (`  h@   h`   h@  !x@  (@   (`@   (`   (``  "x@ @  x@@  "x@  "x @  *x@  "x@   (@ #8@  !x@  !x  !x  *x  2x "  2x  0 x  @  x x x   @   # x % (  @ ' h ' (  h &x "x  h@ "8 @ "8  x x  h  h  h@   x  &x@  &x@@  &x@ !x &x  x  &x  h@  &x@  &x@   x &x@  h@  h  h @  h@@  h@@  h@  h @  h@  h "x  h0  h@  H  h@ #8@ ' h@ ) h & h@ & h & ( & h` & H  h ) h@  h` *  +  -  !xf@@ "xf@  "x`f @  "x@   (f@@ . h  h` # h  8 *"8@ @ *"x@ *"x@ *"8@ *"8 @ * ( * x 0 8@@ 0 ( 0 x 1#8@ 1#8@  x    h !x  !x @  !x 9Z0@ 9Z0@ 1x@@  1x@  1x` @   8@    x  #"x  $"8 #"8 $"x 9Zx@ @ 9Z0@ 9Z0@   8`   8`@   8`   8``  "x  x@  x @  "x@  "x @  "x  "x  *x@ *x "  *x * "x *x *x@ "8 "" x  "x@@  x *x@@ *x@ *x @  x@@  x@  x @  "x  "x@  "x  x@  x  x 83ffff̙3f3fff3f3f33333f33333\`PCSE FORM 100-A Rev2008  ;8zr8$G%$(+3  @@   NOTE : ,TPursuant to CSC Resolution No. 021279 dated October 7, 2002, the taking of the ,%*,,;*ZPencil (PPT) or Computer-Assisted Test (CAT) shall be once in three (3)Q-Tmonths and up to four (4) times only. Examinees failing on the fourth attempt may *-*Tapply for the same level of the Career Service Examination only after two (2) yearsA-A IMPORTANT > K - Please see Back Page for Other Important Examination Information -(1"THIS FORM IS NOT FOR SALECIVIL SERVICE COMMISSIONREPRODUCTION IS ALLOWED Education AGENCY/OFFICEDate of Examinationstatistically improbable. I likewise agree that I will subject myself to a validating examination in case the test results in my place of examination are! Place of Examination Rating(from the date of the fourth examination.ZCivil Service Professional or Subprofessional Examinations, via Paper and "YES [ ] NO [ ] DECLARATION:T____________________________________________________________________________________ POSITION/JOB3STATUS OF APPOINTMENT/ EMPLOYMENTFROM Course/DegreeADDRESS/1. APPLICANT'S NAME (PRINT IN CAPITAL LETTERS)C REGIONAL OFFICE WHERE YOU FILED YOUR APPLICATION TO INQUIRE K DAYS BEFORE THE EXAMINATION, PLEASE VISIT OR CALL THE 4. COMPLETE MAILING ADDRESS  9. BIRTHDATE:$12. HIGHEST EDUCATIONAL ATTAINMENT:  13. PRESENT EMPLOYMENT o Government o Private o None  & (@ Aa bj R14. CIVIL SERVICE/BOARD/BAR/EXAMINATIONS PASSED (Use separate sheet if necessary)01Region: _________________K IF YOU FAIL TO RECEIVE YOUR NOTICE OF ASSIGNMENT FIVE [5]  1. This Application Receipt * 2. One [1] blue or black ballpen $ 3. Lead pencil/s no. 2 and eraser/s' BRING THE FOLLOWING ON EXAMINATION DAYTOf[READ THE EXAMINATION ANNOUNCEMENT. DO NOT APPLY IF YOU ARE NOT QUALIFIED]AddressInclusive Years Of AttendanceHighest Grade/Year/ (LAST NAME)DATE LAST TAKEN: TITLE OF EXAMINATION APPLIED FOR, (City / Town / Province), Printed Name and Signature of Processor 5. CIVIL STATUS: _______________ (FIRST NAME)eReceived the application for the: [ ] CAT [ ] PPT [ ] Prof [ ] Subprof _ Republic of the Philippines # TITLE OF EXAMINATION LAST TAKEN DATE OF EXAM:,LENGTH OF EXPERIENCE IN PRESENT POSITION/JOB( _______________________0 Signature of Applicant Right Thumbmark# ____________ ____________RDATE: _____________________ Signature of Processor: ________________________ " PPLACE: ___________________________ Date Received/Processed: _________________ % H DATE _____________ _________________________________ OFFICE/POSITIONn If YES, what Review Center? ____________________________________________________________________________  (Signature over Printed Name)I Done this __________ day of _______________________, 20_______. VTIME: ___________________ Printed Name of Processor: _________________________  95( Do not fill-up this portion. For Processor/s only) 4^ A P P L I C A T I O N R E C E I P T Application No. _____________A 4once 2x 3x 4x more than 4x6ACTION TAKEN: APPROVED [ ] DISAPPROVED [ ] OTHER INFORMATION:Area or Regiona)b)c)Preferred Salary:*A. FOR APPLICANTS OF PAPER AND PENCIL TESTA 4. Valid I.D. Card with photo, signature, birthdate ( if7 available), and signature of authorized head of agency3 (Office/School/Postal ID/Passport/License/BIR/SSS)? SCHEDULED EXAMINATION WILL MEAN FORFEITURE OF EXAMINATION&8 * This should be the same as that presented at FEE AND SLOT.  the time of application. * NO I.D., NO EXAM. +B. FOR APPLICANTS OF COMPUTER-ASSISTED TEST=* DO NOT bring cellular phones & other materials outside @ FAILURE TO COME ON YOUR SCHEDULED EXAMINATION WILL MEAN @ of those above-listed, otherwise, they will be confiscated% , FORFEITURE OF EXAMINATION FEE AND SLOT.+ ? by the Security Officers. The Commission will not be liable- for the loss or damage of said belongings. Level of  (Write in full)15. Have you ever been dismissed from the service for cause, or found guilty of crime involving moral turpitude, or of infamous, disgraceful or    immoral conduct, drunkenness or addiction to drugs, or of offense relative to or in connection with the conduct of a civil service  examination?HYES [ ] NO [ ] If YES, attach copy/ies of decisions.&)IAre you a member of any indigenous group? YES [ ] NO [ ]<Are you differently abled? YES [ ] NO [ ]V2. Are you willing to work in the Government? YES [ ] NO [ ]93. If YES, list three (3) preferred Government Agencies:  %4. Preferred Position:  following items:% (For Married Women)(FIRST NAME) (MIDDLE NAME) (LAST NAME)Honors ReceivedAcademicV Subscribed and sworn to before me this ________ day of __________________ 20 _______.1 ADMINISTERING OFFICER@ (Signature above Printed Name)] Applicant's Printed Name: _____________________________________________________(? Birthdate: _____________________________________( Sex: _________________________` Signature: _______________________________________________________________________/ (Name Extension, e.g. Jr., Sr., III)i3. APPLICANT'S MAIDEN NAME: _________________________ __________________________ ____________________ Professional Subprofessional3 Dates of Exam: ____________ ___________ APPLICATION NO. __________PLACE OF EXAM: [__________________ __________________________ ________ _____________________ ________ 0 (MIDDLE NAME) (MI)L 10. BIRTHPLACE : _________________________ 11. CITIZENSHIP: __________035A* ( mm / dd / yyyy )6 ( mm / dd / yyyy )^ 6. SEX: Male Female 7. HEIGHT(m.) __________ 8. WEIGHT(kg) _____________ ')*8CC ABOUT YOUR SCHOOL ASSIGNMENT. FOR NCR APPLICANTS, PLEASE '( F VISIT OUR WEBSITE: www.csc.gov.ph. FAILURE TO COME ON YOUR *; Name of School Attended andJ1. Have you taken the Career Service Examination in less than 3 months?^3. How many times have you taken the Career Service Examination starting October 7, 2002?  r4. Reasons for taking the Career Service Examination: _________________________________________________________ v5. Have you attended review classes in preparation for the examination? ___________________________________________  Zip Code Tel. No:_______________Cell. No:______________0If NO, please proceed to succeeding questions.('2. AGE:_________|1. Pursuant to (a) Indigenous People's Act (< RA 8371); and (b) Magna Carta for Disabled Persons (RA 7277), please answer the!5;!iIf YES, please specify:) YES [ ] NO [ ] 0If NO, please proceed to succeeding questions.fIf YES, have two (2) years already lapsed from the date the fourth (4th) failed examination was taken? 4 ( mm dd yyyy ) IIf YES, you are disqualified to take the Career Service Examination (CSE)('F at this time. You may take the same level of the CSE after three (3) months.&  Graduated not GraduatedLevel/Units EarnedIf not graduated,M16. Have you already passed the same level of examination being applied for? YES [ ] NO [ ]O2. Have you failed the same level of examination for four (4) times or more? DIBARFor Processor Only: I declare under oath that I personally accomplished this application form, and I hereby certify that the information given aretrue, correct and complete statements pursuant to the provisions of pertinent laws, rules and regulations of the Republic ofthe Philippines.WARNING: Impersonation, cheating and other forms of examination irregularity would lead to dismissal from government ____________ service, perpetual bar from taking civil service examinations, disqualification for re-employment in the ____________ government, and/or imprisonment/fine 'v3'3' I declare that the abovementioned information are true. I understand that the acceptance and approval of my application for the examination is based on 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 payment 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 filing of administrative/criminal case/s against me.@ APPLICANT E-RetakersU If NO, you are disqualified to apply for the same level of the CSE at this time.S You may apply for the same level of the CSE only after two (2) yearsJ from the date of the fourth (4th) failed examination taken.T If YES, you are qualified to apply for the same level of the CSE and may proceed, to the succeeding questions.CS FORM No. 100 (Revised 2008)g% 'h(e* +K-x.s w0 1 54G568^ ;<%?@WB4EGHZJO ccf  (U7fr O  dMbP?_*+%&'(RQ?)MHP LaserJet 1020  4 oXX ! 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No. _____________________________ Amount _____________________________ ______________________________________ Printed Name and Signature of Collecting Officer</MBCA & <>   @"`?Nd]&`> %M 2<Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ _______________________________________ Printed Name and Signature of Collecting Officer</MBCAll ( s *>   @,9;](`> |M 0< 4 Passport size (1.5"x2") photo taken within 3 months with FULL Nametag 4 Scanned, computer- generated/enhanced, photocopied, cutout, and pictures without nametag are not accepted<02 $%S]'& j]%S]^'Sjorll * s *$?   @AKO]*`$? `M 0< 4 Passport size (1.5"x2") photo taken within 3 months with FULL Nametag 4 Scanned, computer- generated/enhanced, photocopied, cutout, and pictures without nametag are not accepted<02 $%S]'& j]%S]^'Sjor>@ddJ)    PPee --  JJAABB.=8899@NLNqqssuuCCDDHHIIEEFF7 \pAdmit [BbCSE FORM 100-A Rev2008$ ;=%8X@"1Arial1Arial1Arial1Arial1xArial1Arial1Arial1 Book Antiqua1Arial1Arial1Arial1Arial1 Wingdings1Arial1Arial1Arial1Arial1 Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1 Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1Arial1 Arial Narrow1Webdings1Webdings1Arial1 Arial Narrow1 Arial Narrow1 Arial Narrow1Arial1Arial1Arial1Arial1Arial1Arial1 Arial Narrow1Arial1<Webdings1  Arial Narrow"$"#,##0_);\("$"#,##0\)"$"#,##0_);[Red]\("$"#,##0\) "$"#,##0.00_);\("$"#,##0.00\)%""$"#,##0.00_);[Red]\("$"#,##0.00\)5*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_),))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)=,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)4+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                + ) , *   h  x &x &x  &x &x  h   h  h @  h  h !x  "x  !x  &x  &x  "x @H@  "x @ &x @ &x @ &x @@  h @ @ h x @ @ &x @ &x @A x @ h @&x @&x @A  h @A   h  h  h &x  h   h &x  h  !x  h @"x  "x @H@  h   h    h 0@  (  ( 0@   &x @ ( 6@   h @ @x @A  "x H@  ( @!x )0  "x @  "x @ *x !x @  h   (   ( 0@  ( "x  (  "x  h @&x @ @&x @ h @ "x @ (  (  (    (   ( @ ( @ !8  ( 0@ (  (   h   h 6@  (   h 0@  h    h 0@ !x 0@ ( 0@  ( 0@  (   (   "x I@  x @ @ "x @@ "x A  *x @ "x   ( @#8 0@ !x @ !x @  !x @@  *x @@  2x "  2x  0 x  0@ x x x  @A   # x % (  @ ' h ' (  h &x "x  h @"8 @A "8  x x  h  h @ h @  x  &x H@  &x @ &x !x @ &x  x  &x @  h @@ &x @H@  &x @@  x @&x @ h @@ h @@  h @A  h @ @ h @ h  h A  h @ h @ "x @ h  h H@  H  h 0@#8 0@' h 0@) h & h 0@& h & ( & h  & H  h ) h 0@ h  *  +  -  !x 6@"x  "x  "x 0@  ( 6@. h  h  # h  8 *"8 I@ *"x H@ *"x @H@ *"8 *"8 A * ( @ * x @@ 0 8 @0 ( 0 x @1#8 @1#8 @@ x    h @!x  !x @ !x 92 @92 @@1x 6@ 1x  1x   8 0@   x  #&x  $&8 #&8 $&x 9z I@ 92 H@ 92 @H@   8    8 0@  8   8   &x @ x @ x @A  &x  &x A  &x @ &x @@  .x @.x &  .x . &x .x @.x &8 "& x  &x @ x .x @ @.x @.x @A x @ @x @x @A  &x  &x @ &x @  x @@ x @ x @@ 83ffff̙3f3fff3f3f33333f33333CSE FORM 100-A Rev2008  $#<#OcsvD  dMbP?_*+%&'(RQ?)MHP LaserJet 10204 oXX` 0{0HL`6 0SDDMHP LaserJet 1020-(d"dXX?zG?U} m } m} } $} }  } I} $} } } } } } I} I} I} } } } } } } } I} I $@,@@@,@w@ -@  @ ;@ @ @@;@;@@<@@@@@@@@@ @,@-@&@CS FORM No. 100 (Revised 2008)g_ Republic of the Philippines *!THIS FORM IS NOT FOR SALE CIVIL SERVICE COMMISSION REPRODUCTION IS ALLOWED%Region: _________________#N APPLICATION NO. __________NNNNNd8dSNDATE LAST TAKEN:& ]^d+# TITLE OF EXAMINATION LAST TAKENO > 6 ( mm / dd / yyyy )For Processor Only:dMN DATE OF EXAM: N]^ ? DIBARd( TITLE OF EXAMINATION APPLIED FORO 2 * ( mm / dd / yyyy )  ? E-Retakersdnf[READ THE EXAMINATION ANNOUNCEMENT. DO NOT APPLY IF YOU ARE NOT QUALIFIED]PLACE OF EXAM: & d8 d@ /1. APPLICANT'S NAME (PRINT IN CAPITAL LETTERS)6 AAddc [__________________ __________________________ ________ _____________________ ________ ( d 2. AGE:_________ &  (LAST NAME)   (FIRST NAME) 7 / (Name Extension, e.g. Jr., Sr., III) 8 0 (MIDDLE NAME) (MI)$ ddq i3. APPLICANT'S MAIDEN NAME: _________________________ __________________________ ____________________6 d-% (For Married Women)(FIRST NAME) (MIDDLE NAME) (LAST NAME)*d)4. COMPLETE MAILING ADDRESS Tel. No:_______________ Z Cell. No:______________  Zd\T____________________________________________________________________________________$cc Zip Code Zd/ 5. CIVIL STATUS: _______________ w^ 6. SEX: Male Female 7. HEIGHT(m.) __________ 8. WEIGHT(kg) _____________ ')*8Cddddd8d 9. BIRTHDATE:cL 10. BIRTHPLACE : _________________________ 11. CITIZENSHIP: __________035A*d<4 ( mm dd yyyy ) 4, (City / Town / Province)& d1$12. HIGHEST EDUCATIONAL ATTAINMENT: 6 !!!!dw Level of   Course/DegreeIf not graduated,Q#Name of School Attended and z|Inclusive Years  AcademicRdL Education (Write in full)Highest Grade/Year/`Address P& Of Attendance Honors Received<<d?5&? Graduated ? not GraduatedLevel/Units Earnedy{ FROM TO'')d8L!!$|$$!6$$d8%&&&''''&'')'')d13. PRESENT EMPLOYMENT o Government o Private o None  & (@ Aa bj 6++d, AGENCY/OFFICE----,ADDRESS /(K / POSITION/JOB  ( 4 ,LENGTH OF EXPERIENCE IN PRESENT POSITION/JOB;x3STATUS OF APPOINTMENT/ EMPLOYMENT((.d8d8dcR14. CIVIL SERVICE/BOARD/BAR/EXAMINATIONS PASSED (Use separate sheet if necessary)016GGGGdDel<^}<~ <o<<<< w@!"@#@$@%@&'-@ ()@*@+@,@-i@.@/@0@1@2<@3@4@5-@6@7@8@9@ :-@;<=><@?K@   * Rating 00  Date of Examination    ) 0! Place of Examination 0003d8!J*03111200003d8"d#15. Have you ever been dismissed from the service for cause, or found guilty of crime involving moral turpitude, or of infamous, disgraceful or   6#44444444444444444444444F$6 immoral conduct, drunkenness or addiction to drugs, or of offense relative to or in connection with the conduct of a civil service 6$44444444444444444444444F%6 examination? %46U%6HYES [ ] NO [ ] If YES, attach copy/ies of decisions.&)0%64444444444444444444FZ&M16. Have you already passed the same level of examination being applied for? &44646 "& YES [ ] NO [ ]"& d8'd( I declare under oath that I personally accomplished this application form, and I hereby certify that the information given are6(666666666666666666666d)true, correct and complete statements pursuant to the provisions of pertinent laws, rules and regulations of the Republic of6)666666666666666666666d*the Philippines.6*666666666666666666666d+ I likewise agree that I will subject myself to a validating examination in case the test results in my place of examination are6+666666666666666666666d!,statistically improbable.6,666666666666666666666d>- (../0/( _______________________//Z08050 Signature of Applicant050Z(11Z(22Z37$$$$$8!3 8 Right Thumbmark3 8444443Z(46666666666666664(55XXXXX 6a65V Subscribed and sworn to before me this ________ day of __________________ 20 _______."644446XXXXX(77 8981 ADMINISTERING OFFICER88 8 OFFICE/POSITION8 4884444 8d9H9@ (Signature above Printed Name)49:;d8:Xd ;B;\5( Do not fill-up this portion. For Processor/s only) 42;9999Xd <A<_6ACTION TAKEN: APPROVED [ ] DISAPPROVED [ ] <44<<P<4H DATE _____________ _________________________________&< 4444d = 4= =, Printed Name and Signature of Processor===d8>d8?dD$l<<<V_BB~BBoBBB<|<@$K@A$JB$C$@D$JE$@F$JG$K@H$,@I$@J$@K$@ L$@M$@N$@ O$i@P@Q@R@S@T@U@ VJ0WXYZ[\]^_8@$$>666666d AiA^ A P P L I C A T I O N R E C E I P T Application No. _____________A 2A> BmBeReceived the application for the: [ ] CAT [ ] PPT [ ] Prof [ ] Subprof 2Bdd8C"##d DeDVTIME: ___________________ Printed Name of Processor: _________________________  92Dd E_ERDATE: _____________________ Signature of Processor: ________________________ " 2Edd F]FPPLACE: ___________________________ Date Received/Processed: _________________ % 2Fdd8GddHhH] Applicant's Printed Name: _____________________________________________________(4HdIJI? Birthdate: _____________________________________I3I( Sex: _________________________(IdJkJ` Signature: _______________________________________________________________________4Jd8K@cd LLWARNING: Impersonation, cheating and other forms of examination irregularity would lead to dismissal from government ____________ service, perpetual bar from taking civil service examinations, disqualification for re-employment in the ____________ gove 'v3'3'FL#NM#NN#8O444cd P4XPK - Please see Back Page for Other Important Examination Information -(1"XPK - Please see Back Page for Other Important Examination Information -(1"0Pcd8QBdd4cd8RBdd4cd8SBdd4cd8TBdd4cd8UBdd4cdVH DECLARATION:6VaaaaaaaaaaaaaaaaaaaabcdUWEJ1. Have you taken the Career Service Examination in less than 3 months?6WccccccccccccccccccccecdXsccc*Xc"YES [ ] NO [ ] Xccc=X0If NO, please proceed to succeeding questions.('"X cccccccccccecYscccccccVYIIf YES, you are disqualified to take the Career Service Examination (CSE)('&Y ccccccccccccecdZscccccccNZF at this time. You may take the same level of the CSE after&Z ccccccccccccecd[$[ three (3) months.&[ cZ\EO2. Have you failed the same level of examination for four (4) times or more? 6\ccccccccccccccccccccecd1]s) YES [ ] NO [ ]]ccccc8]0If NO, please proceed to succeeding questions.]c&] ccccccccccccecdd%^ ^n^fIf YES, have two (2) years already lapsed from the date the fourth (4th) failed examination was taken?^&^ %_ _\_T If YES, you are qualified to apply for the same level of the CSE and may proceed&_ Dl<<<<rRR<<<<<<Rl`abcde@f;@g@h@iw@j@ki@li@mn,@o,@p@ qrFstFuv@w@xyz@{|}~`` `4`, to the succeeding questions."` a]aU If NO, you are disqualified to apply for the same level of the CSE at this time."a b[bS You may apply for the same level of the CSE only after two (2) years"b cRcJ from the date of the fourth (4th) failed examination taken."c idC^3. How many times have you taken the Career Service Examination starting October 7, 2002?  6dDcecddeC<e4once 2x 3x 4x more than 4x.eecddf Professionalf;f 3 Dates of Exam: ____________ ___________ f c fedd g +g c# ____________ ____________geddh h ceddi Subprofessionali;i 3 Dates of Exam: ____________ ___________ i c iedd j@88 +j c# ____________ ____________jedd8kddddddddedd8lsddddddddedd}mCr4. Reasons for taking the Career Service Examination: _________________________________________________________ 6mccccccccccednCv5. Have you attended review classes in preparation for the examination? ___________________________________________ 6nccccccccccccccccccccecd{osn If YES, what Review Center? ____________________________________________________________________________ 6occccccccccccccccccccecd8pijjjjjjjjjjjjjjjjjjjjkcdq I declare that the abovementioned information are true. I understand that the acceptance and approval of my application for the examination is based on the abovecited declaration.4q6r844444444444444444444444s I therefore agree that, in case a post-verification yield information contrary to what is declared, my application shall be disapproved and my payment forfeited.4s6t844444444444444444444444u In addition, I agree that any misrepresentation made in this document may cause the invalidation of the result of this examination and/or the filing of administrative/criminal case/s against me.4uTv5I Done this __________ day of _______________________, 20_______. 6v666666666666666666666ddd8w566666666666666dddx6666666666 Hx [@ APPLICANT"x [[[[[[[[ddddddyII66666666 'y 5 (Signature over Printed Name)"y 6666666ddddddd8zdd7$$$$$$$ddddddd{NOTE : ,e{TPursuant to CSC Resolution No. 021279 dated October 7, 2002, the taking of the  ,%*,,;*b|ZCivil Service Professional or Subprofessional Examinations, via Paper and e}ZPencil (PPT) or Computer-Assisted Test (CAT) shall be once in three (3)Q-c~Tmonths and up to four (4) times only. Examinees failing on the fourth attempt may *-*_Tapply for the same level of the Career Service Examination only after two (2) yearsA-Dls@s<<<::<o<fig@ J0@,@@Z@;@,@@x@ <@<@<@<@ F0FFFFFFFFFF0(from the date of the fourth examination.8dddddddddddddddddddddddddHOTHER INFORMATION:6aaaaaaaaaaaaaaaaaaaabdddE|1. Pursuant to (a) Indigenous People's Act (RA 8371); and (b) Magna Carta for Disabled Persons (RA 7277), please answer the!5;!i6cccccccccccccccccccceddds following items:6cccccccccccccccccccceddd ~a)cQcIAre you a member of any indigenous group? YES [ ] NO [ ]2cccccccccccccccccceddd sc$cIf YES, please specify:2cccfffffffffffffcceddd ~b)cDc<Are you differently abled? YES [ ] NO [ ]2cccccccccccccccccceddd c$cIf YES, please specify:2cccfffffffffffffcceddd8scZZZZZZZZZZZZZZZZZccedddaEV2. Are you willing to work in the Government? YES [ ] NO [ ]6ccccccccccccccccccccedddJE93. If YES, list three (3) preferred Government Agencies:  %cccccccc Area or Region$ cceddd ~a)6cfffffccfffffcffffcceddd ~b)6cgggggccgggggcggggcceddd ~c)6cgggggccgggggcggggcceddd"E4. Preferred Position: cccfffcY hPreferred Salary:$ cccgcg}}}Dceddd8ijjjjjjjjjjjjjjjjjjjjkddd8ccccccccccccccccccccccddd8ccccccccccccccccccccccddd8ccccccccccccccccccccccddd8ccccccccccccccccccccccdddLA IMPORTANT >  / l' BRING THE FOLLOWING ON EXAMINATION DAY TTTTTTTTTUVWoq ' m 1. This Application Receipt  4444444444n5o*A. FOR APPLICANTS OF PAPER AND PENCIL TEST@@@@@@@pq 2 q* 2. One [1] blue or black ballpen 4444444444n44SqK IF YOU FAIL TO RECEIVE YOUR NOTICE OF ASSIGNMENT FIVE [5] 4444444pq , q$ 3. Lead pencil/s no. 2 and eraser/s 4444444444n44SqK DAYS BEFORE THE EXAMINATION, PLEASE VISIT OR CALL THE 4444444pq I qA 4. Valid I.D. Card with photo, signature, birthdate ( if 4444444444n44KqC REGIONAL OFFICE WHERE YOU FILED YOUR APPLICATION TO INQUIRE 4@@@884pqV ? 47 available), and signature of authorized head of agency 444444444n44PqC ABOUT YOUR SCHOOL ASSIGNMENT. FOR NCR APPLICANTS, PLEASE '( 4444444pqV ; 43 (Office/School/Postal ID/Passport/License/BIR/SSS) 444444444n44SqF VISIT OUR WEBSITE: www.csc.gov.ph. FAILURE TO COME ON YOUR *; nVV @ W8 * This should be the same as that presented at 4WWWWWWWWn44Jq? SCHEDULED EXAMINATION WILL MEAN FORFEITURE OF EXAMINATION&WWWWWWWnVVW " W the time of application. WWWWWWWWn44r FEE AND SLOT. WWWWWWWnVV ' W * NO I.D., NO EXAM.  WWWWWWWWWn6o+B. FOR APPLICANTS OF COMPUTER-ASSISTED TESTWWWWWWWnV J V=* DO NOT bring cellular phones & other materials outside  WWWWWWWWWWnDl4<X[ll<HHH<<<<<iFFF MV@ FAILURE TO COME ON YOUR SCHEDULED EXAMINATION WILL MEAN WWWWWWWnV M V@ of those above-listed, otherwise, they will be confiscated%  WWWWWWWWWWn9V, FORFEITURE OF EXAMINATION FEE AND SLOT.+ WWWWWWWnV G V? by the Security Officers. The Commission will not be liable WWWWWWWWWWntuuuuuuuvV 5 t- for the loss or damage of said belongings. uuuuuuuuuuv i<w]*U@]*U@]*@]*ff@]*@]*UU@],f g @],f f @],  uf_f @],  Hf Cg @],  Uf g @],  i i @],  i i @],ui _i @],Hi Di @],i i @]*@]*GK@],6 @],C6 @]* /@]*d d@]* @]*d d@]* @],% @]*%@]*1@]*%%%@]v1`= @rEmail add:______________D b]n"^`W @@sYES [ ] NO [ ]'Vj], % +=i @t2Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ ______________________________________ Printed Name and Signature of Collecting Officer/MBCA].!&?Nd @v2Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ _______________________________________ Printed Name and Signature of Collecting Officer/MBCA]\"(,9; @0x 4 Passport size (1.5"x2") photo taken within 3 months with FULL Nametag 4 Scanned, computer- generated/enhanced, photocopied, cutout, and pictures without nametag are not accepted2 $%S]'& j]%S]^'Sjor]\#*AKO @0z 4 Passport size (1.5"x2") photo taken within 3 months with FULL Nametag 4 Scanned, computer- generated/enhanced, photocopied, cutout, and pictures without nametag are not accepted2 $%S]'& j]%S]^'Sjor=%8X> " Oh+'0' `h  $$CSEForm 100-A Rev2007-Edited File Examination Application Form EAD & PSDAdmitMicrosoft Excel@P@6]@JPG&' F    '' ' ~}h- ~}h ~}h-- @ !-""- @ !"-33- @ !3-DD- @ !D-MM- @ !M-aa- @ !a-ss- @ !s-- @ !-- @ !-- @ !-- @ !-- @ !-- @ !-qq- @ !q-tt- @ !t-- @ !-- @ !-- @ !-  - @ ! -- @ !-  @ !- ~}h-- @ !-- @ !-Arial-  2  1 2 # 2 2 4 3 2 = EM4 2 O 5 2 a bs6 2 t 7 2 8 2 92 10 2 11 2 BA 2 rrtB 2 ~C 2 D 2 E 2 F 2 BG "SystemP-'-  Arial- 42 CS FORM No. 100 (Revised 2008) --'- " 2 _ Republic of the Philippines   -'-  Small Fonts--'- 3# -2 #THIS FORM IS NOT FOR SALE2--'-  +2 #FCIVIL SERVICE COMMISSION       -*2 4REPRODUCTION IS ALLOWEDN Arial- -- -'-  D4-- ---  2 4HRegion: -$2 4y _________________O-- -'-   Small Fonts- - -- - Arial- - -'-  -- -- - -- -   2 1- 2 $. - !2 ,APPLICANT'S NAME    - 2  - .2 (PRINT IN CAPITAL LETTERS)-- -'-  -'-  a N 2 O2 O-- -- -- -- -- -- -- -'-  sb--  <2 `N# TITLE OF EXAMINATION LAST TAKEN       -- -'-   t 2 t2 t-- -- -- -- -- -- -'-  --  72 W TITLE OF EXAMINATION APPLIED FOR       -- - -- -- -- -- -- -- -- -- -- -- -- -- -- -'-  -- -- --  2 4T[READ THE EXAMINATION ANNOUNCEMENT. DO NOT APPLY IF YOU   "2 ARE NOT QUALIFIED]-- -'-  -'-  -   -- @ !-- @ !-- @ !-  - @ ! -qq- @ !q-tt- @ !t-#4- @ !#-- @ !-a- @ !P-  -a- @ !fa-   -Ea- @ !E-# a - @ !># -b- @ !$b-  -- @ !f-   -EqNq- @ ! Eq-EtNt- @ ! Et-EN- @ ! E-#N- @ !+#-#N- @ !+#-t  - @ !t -b- @ !$b-- @ !.-- @ !-qq- @ !q-tt- @ !t-- @ !-- @ !-- @ !-  - @ ! -- @ !-qq- @ !q-tt- @ !t-- @ !-- @ !-- @ !-  - @ ! -- @ !-- @ !g-""- @ !g"-33- @ !g3-DD- @ !gD-MM- @ !gM-aa- @ !a-ss- @ !gs-- @ !-- @ !g-- @ !g-   @ !g-   -- @ !g--'-   , -- -'-  -   -- @ !-- @ !-'՜.+,00@Hp   Roderick Romualdo / Gemma LoCivil Service Commission CSE FORM 100-A Rev2008$'CSE FORM 100-A Rev2008'!Print_Area  Worksheets Named Ranges  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXY[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntryF@òcBook ZėWorkbook;SummaryInformation('DocumentSummaryInformation8