(To be filled-out by the Person-in-Charge of Scholarship /

HR or Admin Officer / Personnel)

DAP-PMDP-SEC, F3, Rev.0

 NAME OF NOMINEE

CONFIDENTIAL

This certifies that the nominee is considered high-performing and high potential and qualifies
based on the following criteria/requirements of the PMDP:

Criteria Qualifications
Nominee holds Position:
a permanent Date of Appointment: Salary Grade:
position Division/Department: DAP-PMDP-SEC, F3, Rev.0
 Criteria Qualifications
Office Address:
Office Contact Info:
Is the position permanent / regular?  Yes  No
Is the nominee designated to another role/function?  Yes  No
If yes, state Position: Salary Grade:
equivalent to Designation Date of Designation Order:
SG 25 and Information on Immediate Supervisor
above Name:
Position:
Contact Details: DAP-PMDP-SEC, F3, Rev.0
 Criteria Qualifications

Nominee Professional Eligibilities If pursuing 3rd Level

satisfies Certifications  PD 907 eligibility, check stages
government  RA 1080 passed
required  PRC, specify  CS Professional
eligibility. area  Career Service Executive
 MATB
___________ Eligible
 Assessment Center
(Please check  Career Executive Service
 Validation
applicable  Bar Exams Eligible
 Panel Interview
boxes)  Career Executive Service Officer
state rank ______ DAP-PMDP-SEC, F3, Rev.0
 Criteria Qualifications
Nominee is 55
yrs. old or Birthdate: ___________________ Age:
below mm / dd / yyyy

Nominee holds Highest Degree and Year of School:

a Bachelor’s educational Specialization: Graduation:
degree attainment:

DAP-PMDP-SEC, F3, Rev.0

 Criteria Qualifications
Nominee got (Indicate year, check applicable period and put rating)
VS/ higher
PAR rating for Year: _____ Rating Year: _____ Rating Year: _____ Rating
the past 2 1st Semester _____ 1st Semester _____ 1st Semester _____
years 2nd Semester _____ 2nd Semester _____ 2nd Semester _____

Total number of years of service in government? __________

DAP-PMDP-SEC, F3, Rev.0

 Criteria Qualifications

Does the nominee have a record of habitual leaves (a maximum of 2 months/year)?  Yes  No

Does the nominee have any pending administrative and/or criminal case?  Yes  No

DAP-PMDP-SEC, F3, Rev.0

 Criteria Qualifications

Please cite other information that will

support nomination to PMDP.

The nominee must submit additional requirements such as Personal Data Sheet, copy of
Appointment Papers, copy of Transcript of Records and Nomination form signed by the head of
agency. As part of the screening process, the nominee will undergo an examination and an interview.
DAP-PMDP-SEC, F3, Rev.0
___________________________________________ ______________________
Name and Signature of Person Completing this Form Position

___________________________
Date Accomplished

DAP-PMDP-SEC, F3, Rev.0