= eben Serres apical be Pgpes american cw tice ColnSsON Soe, Pepe Oat ene, ees CS Form 101-6 (Revised, Dec. 2011) - Piva Seem area see, Applicaton fr Grant iy Psi : cat CSC MC No. 11, s. 1996 as amended (Category Il) Scie oe eee ae Field fice concemed Noe: Ths Frm may be accomplished ster handeriten typewriter or comput rife, provided thal the nature dhe applicant shouldbe handriten, Digtalscanned signature sstictly not alowed) “apPLoATeNNe = ‘2. MOTHER'S MAIDENNAME: ee mee ae pei sets aes 2 COMPLETEPERNMENT ALG ADDRESS ii 1.SEXqw___ 5 OMTECFBRT ty, 6 RACEOF FT Cena ca 7 SATUSO Sige © Meret © Lngay epd O Aled © Wend © Obes, ey a oTaENSH TEN. {LCRLUURPONENO: EWALADORESS 12. EDUCATION (Highest Educational Attainment) LewldEacstn: Oonriny © HpSced © Colege © Mae’ © Doves ‘Completion: © Graduated © Not Graduated fot graduated, highest Grade/YeariLevelUnits eamed: Yoni te etalon mm —— Complete Tite of CourseDegree forestoge, masts doctra: re Nano atenolol vapor ‘2 ENPLOWMENT rset & Pon Ageny/Ofice Address Positiontob Title ‘Status of Appt /Employment Inclusive Years Gov't Service? 14, Temporary Appointment Information capone, sunt Dae tt et tag Neng, rs anthony are ag Aa 15. Other Bligibityfes: TileofEligbty 1) 008 tf Conferment oti 2 | declare underoath tit personally accomplished this Fam, anthal heinfornatin gen aetue, cect nd complet salerents pursuant the provisions of pertinent las, nlesand regatons ote RepblicothePhprines | ucerstand hat ny mistepresentaen madein his document shallcausethe dsapprova cfmy applcaten andl outright ‘evocation fhe egy aranied witout prjuicoto the ing of adinistrvelriminal cals against me. Dine ot ea sora am Senate rt piriednae Te onicat ‘Sitsctbodand:wom tetrenetis Aye mie TSiretsecrtpiednareciaTieng wr _—Oeanton INDORSEMENT (CSCFO to CSCRO aor CSCRO to CSCCO; To be fled up ONLY as applicable): ENDORSING the application of toCSCRONO ICSCCO asreceivedby CSCFO. CSCRO No, on. ‘or approval and processing ofthe grantof Skil (Category I) eighty. Signature over full printed name of CSC Field/Regional Director / Date ACTION TAKEN (for Processors only): © Approved -O Disapproved due to O For Compliance ee ine fo RNa llonnnn | TtecfEigbity at tect tt. [Oale: :________ | Cettiicate of Eligibility No.. ‘Seria No. Remarks. hone hace ‘Salue citi pirednaned "PoceserDae _ _~_ Sinaue ort pied ane PromssarDae APPLICATION RECEIPT =e Roadie heappatondt Raed = rae ras — | ere —____ Se ares | sachets, ~ aac || “tan Sa ~| aro ety unde seis &CSCisurcns = CSCROVF. See, (eases cree | Shiono Serna cee Sond ee ‘grave over pind name Racing Oca |: weiss creas svete res asamp eer WRU(For 8c Peceseors ony) |. QUALIFICATIONS FOR THE GRANT OF SKILL ELIGIBILITY (Category I) [As Checklist of Qualifications {Q_ t. Tie ofpolin incdedin fe tof postions under CSCMGNo. 11. 1BBIOSCMCNo.8.2008 Specty complete of tn, 1D. 2 Stas of appinmentindcated on appcintrent pope is Teporay 5. Rendered service under temporary sta for one your o teat 10 months Speci incusve dats: From (rmidaiyyy) a To (ody) —_______ 4. Rendeted Vary Satfacory acl work perloranca fer Be We rng pes cng the one year lorparay aspohiment Evaluation on Qualifications forthe Grant of Eligibility ‘© used (a qusfcaton stare mel). Appleton fr approval (© Not quale. Applicaton for disapproval. Spectyqualicafons not met "DOCUMENTARY REQUREEMENTS FOR SUBNESSIN (To be accomplished ony for qualified appcatons; Pu strik fr lacing ems andor na” tems nt appticabe) |A, Checklist of GENERAL REQUIREMENTS: {Dt Proper accompished CS Form 101-5, Revised Dec. 2011 (a lis prop ld out, wih na indcaed ina lds rat angele to he appar) D2 Tree 8) pees of ential recent LD icurs with the folowing spesestons: Passport se (45 on x25) in white tackgrourd 1 Pris on quality pots paper Oinbate toe etaceye gases oneal lane nid awe ane tre 1 Showing let an ght oars Onstanccossun sc fen Sec ep wh eta ec al tm che th ere pay ev fe) |S Win enters wet ot cogutes a tie sae tn showin sana or comet es rae informal Fis Nae te Lat Nano tenn Nao NOTE: 00 NOT ACCEPT 1D. PICTURE IF NCT WiTH ALL OF THE ABOVE SPECFFICATIONS. '_3. Ofna and photocpy of any ofthe follwing LD. cats, whch rst te valid (ot xpd) upen fing of appicaton and bea the aplcants rane, pce and sonata, ‘andthe sg oe’ name and sgratie (NOTE: Any aber 1D. cart NOT iced in th et shat NOT be acted ice the 1D. cars suomi bythe applicant) + Curent Otice!Company 10, GS UMD PhiMalh 0 (ATM ype) Seton LD. (rust be ely veldts for fe cuent schoo! year) $88 10, + Voters 10, Passport (wih signature of he apace) + PRC License + Postal iD + BR LD. (ATH ypotamnstos card weh pice type) + Divers Leerse + Barangay 10. + Police cesrance (wih pcr) 4. Orginal ant photocopy of ith Certiate ofthe apleatsuenicetedoued bythe NSO fe: cash NSO Sth tse sc pe, ha NSO ha yd Nag Catster SOS Font pn nNSOsoay or healers natn sri ace encrtopyshr Beh Cac asked eal laser] 5. Forforaa marred apicans, orignal and peiocopy of Mariage Gertiole autentatedsaued by he NSO (oe Ice a NSO Mage aint pc ‘ar attr sur org ang tsb Monae Cot adrian ae Cl Rep) 6g of appeaton i tough a represent: (2. Autboreaton ltr execs by he appicant and Cl Ogal and photocopy of ne (1 vd 1D, cad ofthe representa, ‘Checklist of SPECIFIC REQUIREMENTS: Skil Etigibity (Category m) {Q.7, Onl and phoiccoy of Agpottnant Paper cf ne applcan,speccaly indicating the sts of appointments “Tempore |NOTE: No sas of apocinet cher an “Tempary’ cal be conser fo fe grant of ey under Cap. except pastors conaed uncer Cag (sere play ne Novrber 201 Redsed Cuseines and Poceies on gn of egy unr soa laws and CSC karen) 6. Catcaion (sing the pescibed CSC-ERPO Cat! For No.1, Revsed Cet 2008) kom to agency headhiahest HNO that he appre ean at ast Very Salary rang for fe to rig perods dung the one-year tomgorary appointment 9, Silene of Acuel Dues ant Resporsibles (sgt pesabed C$C-ERPO Cat I Fom No.2, fan 20) ole apicart exec by he apart reco supesor D_ 10.ubentaed copy of he applicants Peorrance Rang Fo, diy confimad by the agency's Peformance Evauston and Revew Commies (PERC), fr fe Wo ‘ating pried covered bythe one-year tamporary apginent CC. Evaluation on Documentary Requirements Submitted © Complete documens. © Incompetefacing documents. Seo toms in the above checkisls marked with astersk (for complanc, © Inanectdocumens.Speatydefcionoyies Spectyreqtels toads the defenas (© Data on documents wih dscrepanoyles Specty ésaepanoes Spectyrequstels to acres fe decepareles ‘Snare oe fl pind name of Processor ‘Stra oer ul pried rame of 2 Processor eee ees agg CERTIFICATION (Tobe acampshed ony for qualied applicants wih complete documents: 7 We crt that we have reviewed the qualfesons and al the Gocumenanyrequcements suomi by nce appaton for grat the Sal elgby(Ceegery and curd te same tobe cone an ode, ‘Signature ovr ul printed name of 1 Proeasor ‘Snare over ul pried rae | er CERTIFICATION (Tobe acompshed only upon submission of ALL. document for complancalregulstesederessing deiendes andor dcepances Wie coy that has submited on he marked documents fr comancoequies adessing raked defences andlor dscrepandes. We Fart cay To Fave Yevoued the compl docnverivemuie and Youd the same tobe slslacoy and in ore. ‘Signature over fl printed name of" Proessor ‘Snare oer ful preted rare ot 2 Prosssor Date Poston Date Psion CSC Regional Office No. may be reached at CSC Field Office may be reached at the following contact numbers: the following contact numbers: Telephone Telephone Cellular Cellular Fax Fax E-mail add E-mail add Contact Person Contact Person