TASK LIST FORM

Guidelines
1. Please keep the integrity of the Task List Form. Do not alter, edit, revise any part of the form.
2. Accomplish the form from numbers 1 to 11 completely and accurately. If not applicable, write "N/A". DO NOT abbr

3. Have a separate file / Task List Form for every personnel. Filename should be letter of first name, letter of middle
(e.g. Full name: Mark Daniel G. Diosana File name: mgdiosana.xls)

4. Consolidate accomplished forms per office and send to nia.msdcorplan@gmail.com

5. Print a copy for signature of Employee and Immediate Supervisor.

1 NAME
1a Surname 1b First Name 1c Middle Name

2 DATE OF BIRTH (mm/dd/yyyy) 3 GENDER

3 ORIGINAL APPOINTMENT Mother unit or organization where your plantilla position 4 IF DETAILED Indicate u
is located
3a POSITION TITLE 4a CURRENT DESIGNATIO

3b SALARY GRADE 3c STEP INCREMENT 3d MONTHLY SALARY

3e REGION / PROJECT 3f DEPARTMENT 3g DIVISION 4b REGION

3h SECTION 3i IMO 3j SYSTEM 3e SECTION

UPRIIS
5 STATUS OF APPOINTMENT 6 EDUCATIONAL ATTAIN
Regular (COB)

Monthly Permanent Item No. Primary Education

Casual (PS - Authorized Daily) Secondary Education
Job Order / Contract of Service (MOOE) College Graduate

Post Graduate Studies

Projects (Specify name of Project)

Charged to Subsidy 7 ELIGIBILITY Appropriate

PD 907 RA 1080
✘ Contractual / Monthly Coterminous with the Project (PS)
First Level Eligibility
Item No.
Casual (PS)
8 DATE HIRED Date when f
hired in NIA (mm/dd/yyy
Job Order / Contract of Service (MOOE)

Charged to Project (FSSM / IDP - Direct Cost / ROW / Construction Survey)

Casual (PS) 10 LENGTH OF SERVICE N

Job Order / Contract of Service - Excluding 10a Number of years
"Pakyaw Contract"

ACTUAL DUTIES Statement of duties/tasks actually performed to give accurate information in what you are pr
11 (If involved in projects, site the names of projects) Additional sheets may be used if necessary

Description of Activity Volume / Frequency

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

11)

12)

13)

14)

15)

PREPARED BY: REVIEWED BY:

NAME AND SIGNATURE OF EMPLOYEE NAME AND SI

 DO NOT abbreviate.

ter of middle initial , and surname.

ame 1d Suffix

LED Indicate unit or organization where you are reassigned

T DESIGNATION

4c DEPARTMENT 4d DIVISION

4f IMO 4g SYSTEM

ONAL ATTAINMENT Highest education / degree attained

y Education
ary Education
Graduate

aduate Studies

TY Appropriate Civil Service Examination Passed

RA 1080 Professional Sub Professional None
ligibility Second Level Eligibility Others :

ED Date when first

A (mm/dd/yyyy) 9 DATE OF LAST PROMOTION
(mm/dd/yyyy)

OF SERVICE Number of years of service rendered in NIA

of years 10b Number of months

hat you are presently doing with an output/result of your task.

/ Frequency Time consumed per task

ED BY:

NAME AND SIGNATURE OF IMMEDIATE SUPERVISOR

 ACTUAL DUTIES Statement of duties/tasks actually performed to give accurate information in what you are
projects, site the names of projects) Additional sheets may be used if necessary

Description of Activity Volume

11)

12)

13)

14)

15)

16)

17)

18)

19)

20)

21)

22)

23)

24)

25)

26)

27)

28)

29)
30)

31)

32)

33)

34)

35)

36)

37)

38)

39)

40)

PREPARED BY:

NAME AND SIGNATURE OF EMPLOYEE

in what you are presently doing with an output/result of your task. (If involved in

Volume / Frequency Time consumed per task

REVIEWED BY:

NAME AND SIGNATURE OF IMMEDIATE SUPERVISOR