ࡱ>  \pERPO Ba==%8X@"1Arial1Arial1Arial1Arial1xArial1Arial1Arial1( Book Antiqua1Arial1Arial1Arial1Arial1" Wingdings1Arial1Arial1Arial1Arial1( Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1( Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1( Arial Narrow1 Webdings1 Webdings1Arial1( Arial Narrow1( Arial Narrow1( Arial Narrow1Arial1Arial1Arial1Arial1Arial1( Arial Narrow1Arial1 <Webdings1(  Arial Narrow1Arial1dArial1( Book Antiqua"$"#,##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 @  (    (`  (`@  (`  (``  h`f @   h@@   (`  h@   h`   h@  !x@  (@   (`@   (`   (``  "x@ @ x@@  "x@  "x @  *x@  "x@  !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@ & 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 . 8@@ . ( . x /#8@ /#8@  x    h  ( #8 #8 !"  x  *x@@ x "x@ "x "x` x  "8  "x  "x@  "x  x@  x  x  "x@@  "x@  "x @ *x@ *x @  "x ""x #"x 3 x@@ 3 x@ 3 x @ *x "  *x *  "x "x *x *x@ ""8  x@  x @  "x  "x  *x@ 9Zx@ @ 9Z0@ 9Z0@ !x  !x @  !x 9Z0@ 9Z0@ 1x@@  1x@  1x` @   8@      8`   8`@   8`   8`` #"8 83ffff̙3f3fff3f3f33333f33333\` UOback ȇfront  ;J  ;Vz@<G%$(+$3  @@   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"YES [ ] NO [ ] DECLARATION:T____________________________________________________________________________________FROM 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)_ Republic of the Philippines # TITLE OF EXAMINATION LAST TAKEN DATE OF EXAM:( _______________________0 Signature of Applicant Right Thumbmark# ____________ ____________PPLACE: ___________________________ Date Received/Processed: _________________ % H DATE _____________ _________________________________ OFFICE/POSITIONn If YES, what Review Center? ____________________________________________________________________________  (Signature over Printed Name)I Done this __________ day of _______________________, 20_______. 5( 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 [ ] A 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. =* DO NOT bring cellular phones & other materials outside @ of those above-listed, otherwise, they will be confiscated% ? 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.&)% (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)* ( mm / dd / yyyy )6 ( mm / dd / yyyy )C 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 and^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:_________) 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? 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 &v1&1& 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):1. Have you taken the Career Service Examination before?4 ( yyyy mm dd ) RANK$LENGTH OF EXPERIENCE IN PRESENT RANKSTATUS OF APPOINTMENTPENOLOGY OFFICER EXAMINATIONAReceived the application for the: PENOLOGY OFFICER EXAMINATION$2I 10. BIRTHPLACE : _________________________ 11. CITIZENSHIP: __________-02>\ 6. SEX: Male Female 7. HEIGHT(m.) __________ 8. WEIGHT(kg) _____________ %'(6AUTIME: _7:00 AM__________ Printed Name of Processor: _________________________  4 8RDATE: NOV. 9, 2008_________ Signature of Processor: ________________________ 2 " % &1K(r)_+7a,r$.0\ 2m 3 6h8z:[;% =("~?@UDEGH(Н0azp0"""S0t00FP?F6 844444444444444444444444 !4! 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No. _____________________________ Amount _____________________________ ______________________________________ Printed Name and Signature of Collecting Officer<-  A~~ ! <T  @]!`T( 2<Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ _______________________________________ Printed Name and Signature of Collecting Officer<-  All " s *  @]"`TU 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<00$ &]$ ^&\orll # s *d  @]#`dU 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<00$ &]$ ^&\or>@dd@@@2 ??!!77    p֋ tڱb  dMbP?_*+%&'(RQ?)M\\Cherry\HP LaserJet 1200 Serie4C odXXLetterDINU"4J4"dXX?zG?U} m } m} } $} }  } I} $} } } } } } I} I} I} } } } } } } } I} Ip$T0@,@@@,@w@ -@:  @ ;@ @ @@;0@;l0@@<@0@@@0@?@@0@@@TY@-T0@T @ -*      M`MMMMMc8cR M'& \]c .N  e c  M/ M\]  c (N  d   c ! a& c8 c 6 AAcc b( c p  &  ,  [  c$ cc \6 c P Q*c  m Y  n  Yc $bb lYc +  ccccc8c  *c  )& c 6 !!!!c sJ  {P h vx #  SQc L K %_ " O& $  yR<z<c? y zu|w   '')c8L!!$x$$!6$$c8%&&&''''&{'')'')c 6++c ,---- , /(K  /  (   t((.c8c8c 6GGGGcDl^\r<Pr|^<H^H^\d<^dH<<H<< wT0@!"@#@$@%@&'-@ (@)@:*@+@,@-i@.@/0@0l0@1@2<@30@4@5-@60@7?@8@90@ :-@;<T=><T0@T?K@  * 00   0  0003c8!J*03111200003c8"c #L6#44444444444444444444444F $6M6$44444444444444444444444F %6N %46 %6O0%64444444444444444444F &|&44646 & }"& c8'c (6(666666666666666666666c )6)666666666666666666666c *6*666666666666666666666c + 6+666666666666666666666c ,6,666666666666666666666c>-(../ /0//Y0 051050Y(11Y(22Y37$$$$$8 3 823 8444443Y(46666666666666664(55WWWWW 6 65T"644446WWWWW(77 8 8U8 8 868 4884444 8c9 9 V49       :;c8:Wc ; ;[:2;9999Wc < <^=<44<< <45&< 4444c = = =*===c8>c8?cD l~<<HH^^<HHHHHBBXXBBXBBXBhP<RhR<@$KT0@A$JB$C$@D$JE$@F$JG$K@H$,@I$@:J$@K$@ L$@M$@N$@ O$i0@Pl0@Q@R@S0@T@U@V,0YW?YXYY0YZY[Y\Y]Y^T0Y_Y8@$$>666666c A A;2A> B B2Bcc8C"##c D D2Dc E E2Ecc F F42Fcc8GccH  HW4HcI  IXI IY(IcJ  JZ4Jc8K@bc L  L FL#NM }#NN }#8O444bc P4 P~ P0Pbc8QBcc4bc8RBcc4bc8SBcc4bc8TBcc4bc8UBcc4bc8VbbbbbbbbbbbbbbbbbbbbbbbD l<RR<RRR<PfP<hRR<^<<<<<<`$$T0Ya$$Yb$$Yc$$Yd$$Ye$$Yf$$Yg$$Yh$$Yi$$Yj$$Yk$$Yl$$Ym$$Yn$$Yo$$0Y$@, * (  dB  s *D@U]`XldB  s *D@U]`XldB @ s *D@]``YldB  s *D@]`ldB  s *D@]`@ldB  s *D@UU]`ldB  s *D@]`ldB  s *D@GK]`8`X  S  @6]``X  S  @C6]`ldB  s *D@ /]`0ldB  s *D@d d]`ؗldB  s *D@ ]`ldB  s *D@d d]`(ldB  s *D@ ]`Й`X  S  @%]]`xldB  s *D@%]` ldB  s *D@1]`țldB  s *D@n%n]`prr  0H  @1`=]`H <Email add:_____________<D [x % 6  @ +=i]%` 2<Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ ______________________________________ Printed Name and Signature of Collecting Officer<-  A"` & <j  @?Nd]&`j̞ 2<Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ _______________________________________ Printed Name and Signature of Collecting Officer<-  Az"`l ( s *j  @,9;](`jt 0< 4 Passport size (1.5"x2") photo taken within 3 months with FULL Nametag 4 Scanned, computer- generated/enhanced, photocopied, cutout, and pictures without nametag are not accepted<00$ &]$ ^&\orll * s *8k  @AKO]*`8k| 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<00$ &]$ ^&\or>@ddFFF"$FF.=8899@NLNCCDDHHIIEEPP--  JJAABB    \pERPO [Bbbackfront$ ;J$ ;V=%8X@"1Arial1Arial1Arial1Arial1xArial1Arial1Arial1 Book Antiqua1Arial1Arial1Arial1Arial1 Wingdings1Arial1Arial1Arial1Arial1 Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1 Book Antiqua1Arial1Arial1Arial1Arial1Arial1Arial1Arial1 Arial Narrow1Webdings1Webdings1Arial1 Arial Narrow1 Arial Narrow1 Arial Narrow1Arial1Arial1Arial1Arial1Arial1 Arial Narrow1Arial1<Webdings1  Arial Narrow1Arial1dArial1 Book Antiqua"$"#,##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 @ (  (  (    (   ( 0@ (  (   h   h 6@  (   h 0@  h    h 0@ !x 0@ ( 0@  ( 0@  (   (   "x I@ x @ @ "x @@ "x A  *x @ "x  !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@& 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 @@ . 8 @. 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Have you failed the same level of examination for four (4) times or more? 6bbbbbbbbbbbbbbbbbbbbdbc1 o) YES [ ] NO [ ] bbbbb8 0If NO, please proceed to succeeding questions. b& bbbbbbbbbbbbdbcc%   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&    4 , to the succeeding questions."  ] U 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) years" RJ from the date of the fourth (4th) failed examination taken." iC^3. How many times have you taken the Career Service Examination starting October 7, 2002?  6DbdbccC<4once 2x 3x 4x more than 4x.dbcc Professional; 3 Dates of Exam: ____________ ___________  b dcc  + b# ____________ ____________dcc  bdcc Subprofessional; 3 Dates of Exam: ____________ ___________  b dcc @88 + b# ____________ ____________dcc8ccccccccdcc8occccccccdcc}Cr4. Reasons for taking the Career Service Examination: _________________________________________________________ 6bbbbbbbbbbdcCv5. Have you attended review classes in preparation for the examination? ___________________________________________ 6bbbbbbbbbbbbbbbbbbbbdbc{on If YES, what Review Center? ____________________________________________________________________________ 6bbbbbbbbbbbbbbbbbbbbdbc8effffffffffffffffffffgbc 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.46844444444444444444444444 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.4DGl<<Rls@s<<<: T0F!"@#@$w%&@'()*+,-0@.,/0T012@3,0@4@G5Z@6;@7,?@89w:wG;<w@<<@ =F0>T0F?F6 844444444444444444444444! 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.4!T"5I Done this __________ day of _______________________, 20_______. 6"666666666666666666666ccc8#566666666666666ccc$6666666666 H$ Z@ APPLICANT"$ ZZZZZZZZcccccc%II66666666 '% 5 (Signature over Printed Name)"% 6666666ccccccc8&cc7$$$$$$$ccccccc'*8-ccccccccccccccccccccccccc8.bbbbbbbbbbbbbbbbbbbbbccc8/Xbbbbbbbbbbbbbbbbbbbbbccc80bbbbbbbbbbbbbbbbbbbbbbccc81bbbbbbbbbbbbbbbbbbbbbccc82bbbbbbbbbbbbbbbbbbbbbbccc83bbbbbbbbbbbbbbbbbbbbbccc84bbbbbbbbbbbbbbbbbbbbbccc85bbYYYYYYYYYYYYYYYYYbbbccc86Xbbbbbbbbbbbbbbbbbbbbbccc87Xbbbbbbbbbbbccc88bbbbbbbbbbbbbbbbbbbbbccc89bbbbbbbbbbbbbbbbbbbbbccc8:bbbbbbbbbbbbbbbbbbbbbccc8;bbbbbbbbbbbbbbbbbbbbbbccc8<bbbbbbbbbbbbbbbbbbbbbbcccL=A IMPORTANT > = /= h' BRING THE FOLLOWING ON EXAMINATION DAY= SSSSSSSSSTUV>km '> i 1. This Application Receipt > 4444444444j?m 2? m* 2. One [1] blue or black ballpen ? 4444444444j44DL l:<o< <<<<<<<<<<<<<<<<i@T0FAFBFCFDwFEFFFGFHFIFJF KS@mK IF YOU FAIL TO RECEIVE YOUR NOTICE OF ASSIGNMENT FIVE [5] @4444444lm ,@ m$ 3. Lead pencil/s no. 2 and eraser/s @ 4444444444j44SAmK DAYS BEFORE THE EXAMINATION, PLEASE VISIT OR CALL THE A4444444lm IA mA 4. Valid I.D. Card with photo, signature, birthdate ( if A 4444444444j44KBmC REGIONAL OFFICE WHERE YOU FILED YOUR APPLICATION TO INQUIRE B4@@@884lmU ?B 47 available), and signature of authorized head of agencyB 444444444j44PCmC ABOUT YOUR SCHOOL ASSIGNMENT. FOR NCR APPLICANTS, PLEASE '( C4444444lmU ;C 43 (Office/School/Postal ID/Passport/License/BIR/SSS)C 444444444j44SDmF VISIT OUR WEBSITE: www.csc.gov.ph. FAILURE TO COME ON YOUR *; DjUU @D V8 * This should be the same as that presented atD 4VVVVVVVVj44JEm? SCHEDULED EXAMINATION WILL MEAN FORFEITURE OF EXAMINATION&EVVVVVVVjUUV "E V the time of application.E VVVVVVVVj44Fn FEE AND SLOT. FVVVVVVVjUU 'F V * NO I.D., NO EXAM. F VVVVVVVVVjGkVVVVVVVjU JG U=* DO NOT bring cellular phones & other materials outside G VVVVVVVVVVjHUVVVVVVVjU MH U@ of those above-listed, otherwise, they will be confiscated% H VVVVVVVVVVjIUVVVVVVVjU GI U? by the Security Officers. The Commission will not be liableI VVVVVVVVVVjJpqqqqqqqrU 5J p- for the loss or damage of said belongings.J qqqqqqqqqqrfw]*U@]*U@]*@]*ff@]*@]*UU@],  @],  @],  u_ @],  H C @],  U  @],    @],    @],u _ @],H D @],  @]*@]*@], @],C @]* /@]*dd@]*@]*dd@]*@], @]*@]*@]*%%@]v` @??Email add:______________D b],   @??2Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ ______________________________________ Printed Name and Signature of Collecting Officer-  A]. ! @?x?2Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ _______________________________________ Printed Name and Signature of Collecting Officer-  A]\!" @?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 accepted0$ &]$ ^&\or]\"# @?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 accepted0$ &]$ ^&\or=%8X> @@@"  pe\au͇4  dMbP?_*+%&'(RQ?)M\\Cherry\HP LaserJet 1200 Serie4C odXXLetterrt size (1.5"x2") DINU"4J4"dXX?zG?backU} m } m} } $} }  } I} $} } } } } } I} I} I} } } } } } } } I} I p$T0@,w@@@,@w@ -@  T0@ ;@ T0@ @@;@;;0@@<@0@@@@?@p0@@@@Y@-@&@CS FORM No. 100 (Revised 2008)g_ Republic of the Philippines *!THIS FORM IS NOT FOR SALE CIVIL SERVICE COMMISSION REPRODUCTION IS ALLOWED%Region: _________________#M APPLICATION NO. __________MMMMMc8cRMDATE LAST TAKEN:& \]c+# TITLE OF EXAMINATION LAST TAKENN > 6 ( mm / dd / yyyy )For Processor Only:c$PENOLOGY OFFICER EXAMINATIONM DATE OF EXAM: M\] ? DIBARc( TITLE OF EXAMINATION APPLIED FORN 2 * ( mm / dd / yyyy )  ? E-Retakerscnf[READ THE EXAMINATION ANNOUNCEMENT. DO NOT APPLY IF YOU ARE NOT QUALIFIED]PLACE OF EXAM: & c8 c@ /1. APPLICANT'S NAME (PRINT IN CAPITAL LETTERS)6 AAccc [__________________ __________________________ ________ _____________________ ________ ( c 2. AGE:_________ &  (LAST NAME)   (FIRST NAME) 7 / (Name Extension, e.g. Jr., Sr., III) 8 0 (MIDDLE NAME) (MI)$ ccq i3. APPLICANT'S MAIDEN NAME: _________________________ __________________________ ____________________6 c-% (For Married Women)(FIRST NAME) (MIDDLE NAME) (LAST NAME)*c)4. COMPLETE MAILING ADDRESS Tel. No:_______________ Y Cell. No:______________  Yc\T____________________________________________________________________________________$bb Zip Code Yc/ 5. CIVIL STATUS: _______________ u\ 6. SEX: Male Female 7. HEIGHT(m.) __________ 8. WEIGHT(kg) _____________ %'(6Accccc8c 9. BIRTHDATE:`I 10. BIRTHPLACE : _________________________ 11. CITIZENSHIP: __________-02>*c<4 ( yyyy mm dd ) 4, (City / Town / Province)& c1$12. HIGHEST EDUCATIONAL ATTAINMENT: 6 !!!!cs Level of  Course/DegreeIf not graduated,P#Name of School Attended and vxInclusive Years AcademicQcL Education (Write in full)Highest Grade/Year/_Address O& Of Attendance yHonors Received<z<c?5&? Graduated ? not GraduatedLevel/Units Earnedu|w FROM TO'')c8L!!$x$$!6$$c8%&&&''''&{'')'')c13. PRESENT EMPLOYMENT o Government o Private o None  & (@ Aa bj 6++c, AGENCY/OFFICE----,ADDRESS /(K  /RANK  ( , $LENGTH OF EXPERIENCE IN PRESENT RANKtSTATUS OF APPOINTMENT((.c8c8ccR14. CIVIL SERVICE/BOARD/BAR/EXAMINATIONS PASSED (Use separate sheet if necessary)016GGGGcDXl<^<~ <o<<<< wT0@!"@#@$w@%@&'-@ (@)@*T0@+@,T0@-i@.@/@0;0@1@2<@30@4@5-@6@7?@8p0@9@#:-@;<=><@?K@   * Rating 00  Date of Examination ) 0! Place of Examination 0003c8!J*03111200003c8"c#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 [ ]"& c8'c( I declare under oath that I personally accomplished this application form, and I hereby certify that the information given are6(666666666666666666666c)true, correct and complete statements pursuant to the provisions of pertinent laws, rules and regulations of the Republic of6)666666666666666666666c*the Philippines.6*666666666666666666666c+ I likewise agree that I will subject myself to a validating examination in case the test results in my place of examination are6+666666666666666666666c!,statistically improbable.6,666666666666666666666c>-(../0/( _______________________//Y08050 Signature of Applicant050Y(11Y(22Y37$$$$$8!3 8 Right Thumbmark3 8444443Y(46666666666666664(55WWWWW 6a65V Subscribed and sworn to before me this ________ day of __________________ 20 _______."644446WWWWW(77 8981 ADMINISTERING OFFICER88 8 OFFICE/POSITION8 4884444 8c9H9 @ (Signature above Printed Name)49       :;c8:Wc ;B;[5( Do not fill-up this portion. For Processor/s only) 42;9999Wc <A<^6ACTION TAKEN: APPROVED [ ] DISAPPROVED [ ] <44<<P<4H DATE _____________ _________________________________&< 4444c = 4= =, Printed Name and Signature of Processor===c8>c8?cD$l<<<V_BB~BBoBBB<|<@$KT0@A$JB$C$@D$JwE$@F$JG$K@H$,@I$@J$T0@K$@ L$T0@M$@N$@ O$i@P;0@Q@R@S0@T@U@V,YW?YXp0YYYZY[Y\Y]Y^Y_Y8@$$>666666c AiA^ A P P L I C A T I O N R E C E I P T Application No. _____________A 2A> BLBAReceived the application for the: PENOLOGY OFFICER EXAMINATION$22Bcc8C"##c DhDUTIME: _7:00 AM__________ Printed Name of Processor: _________________________  4 82Dc EcERDATE: NOV. 9, 2008_________ Signature of Processor: ________________________ 2 " 2Ecc F]FPPLACE: ___________________________ Date Received/Processed: _________________ % 2Fcc8GccH hH] Applicant's Printed Name: _____________________________________________________(4HcI JI? Birthdate: _____________________________________I3I( Sex: _________________________(IcJ kJ` Signature: _______________________________________________________________________4Jc8K@bc L L 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 ____________ gove &v1&1&FL#NM }#NN }#8O444bc P4XP~K - Please see Back Page for Other Important Examination Information -(1!XPK - Please see Back Page for Other Important Examination Information -(1!0Pbc8QBcc4bc8RBcc4bc8SBcc4bc8TBcc4bc8UBcc4bc8VbbbbbbbbbbbbbbbbbbbbbbbD l<<<<rRR<<<<<<<`$$T0Ya$$Yb$$Yc$$Yd$$wYe$$Yf$$Yg$$Yh$$Yi$$Yj$$T0Yk$$Yl$$T0Ym$$Yn$$Yo$$Y$@,]*U@]*U@]*@]*@]*@]*UU@]*@]*GK@], 6 @], C6 @]*  /@]* d d@]*  @]*d d@]* @],%] @]*%@]*1@]*n%n@]v1`= @Email add:_____________lD [],% +=i @?l?2Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ ______________________________________ Printed Name and Signature of Collecting Officer-  A].&?Nd @?(?2Date: ________________________________ O.R. No. _____________________________ Amount _____________________________ _______________________________________ Printed Name and Signature of Collecting Officer-  A]\(,9; @?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 accepted0$ &]$ ^&\or]\*AKO @?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 accepted0$ &]$ ^&\or=%8X> FFF" Oh+'0 `h  $"CSEForm 100-A Rev2007-Edited File.Examination Application FormFil EAD & PSDn ERPO PSMicrosoft Excel@j@6]@exG?`L>?0M`k. PM $e0$ `t0`  Arialdv%    TT ! B B LP1   ( &% 6% Ld!??   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PM B5 5(? 7dv% % % % % " !% %   4D% % % %   TxH4xC B BH4L\Region: % Ty4C B By4Lt _________________% % % " !% %   Rp  Arial=148?S00  \L?`\L?0M`k. PMP=1 5ȵ?3dv% % Rp  Small Fonts%hR P?S00x    B?` B?0M`k. PM %hR 5?. Vdv% % % % % Rp  Arial$XF<?S00  dD?`dD?0M`k. PMX$XF 5 ,?* Hdv% % % % " !% %   % % % % % % %   TT# B BLP1% TX$+ B B$LP. % T, B B,LpAPPLICANT'S NAME &" WMFC ||p   % TT B BLP % TL B BL(PRINT IN CAPITAL LETTERS)% % % " !% %   % % % % % % % % " !% %   %   T WI B BW LTITLE OF EXAMINATION APPLIED FOR       % % % % % % % % % % % % % % % % % " !% %   % % %   TD4 B B4TL[READ THE EXAMINATION ANNOUNCEMENT. 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DO NOT APPLY IF YOU   "2 ARE NOT QUALIFIED]- - --'- - ,t 12 vZPENOLOGY OFFICER EXAMINATION       --'- - ,a N 2 Q- - - - - - - - --'- - ,sb-  <2 cN# TITLE OF EXAMINATION LAST TAKEN       - --'- - ,--'- - ,-  -- @ !-- @ !-- @ !-  - @ ! -qq- @ !q-tt- @ !t-#4- @ !#-- @ !-a- @ !P- -a- @ !fa- -Ea- @ !E-b- @ !$b- -- @ !f- -EqNq- @ ! Eq-EtNt- @ ! Et-EN- @ ! E-#N- @ !+#-#N- @ !+#-# a - @ !># -b- @ !$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--'-  ,, , --'-  ,-  -- @ !-- @ !-'/՜.+,0@Hp  Roderick Romualdo / Gemma LoFilCivil Service Commission Lo backfront  Worksheets  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcefghijklmnopqrstuvwxyz{|}~     Root EntryFBook dɠWorkbookSummaryInformation(DocumentSummaryInformation8