CSC SPEL Form 1, April 2012

CERTIFICATION
OF NO PENDING CASE/
NON-CONVICTION OF ANY OFFENSE

(complete name of applicant)

(civil status)

(complete address)

This is to certify that I, ___________________________________________, Filipino citizen, of legal age, ______________________________, and a resident of

_____________________________________________________, have no pending administrative and/or criminal case before any court/authorized body. I, further,

(type of eligibility applied for)

certify that I have never been found guilty/convicted of any administrative offense and/or
crime.

I am executing this Certification in support of my application with the Civil Service

Commission Regional Office No. _________ / Central Office for the grant of

___________________________ Eligibility. I understand that any misrepresentation as to the truth of the foregoing shall cause the disapproval of my application and/or

outright revocation of the eligibility granted without prejudice to the filing of administrative
and/or criminal case/s against me.

Done this _______________ day of _____________________, 20________.

________________________________________
Signature over full printed name of applicant
Left Thumbprint Right Thumbprint
/ERPO/PSD/MLGR/LQC/GPL/masfm.041112.b