RDTD-F-102

REPUBLIC OF THE PHILIPPINES

Department of Science and Technology
Philippine Atmospheric, Geophysical and
Astronomical Services Administration (PAGASA)
Science Garden Complex, Agham Road, Diliman, Q.C. 1100

PAGASA Training Application Form

Full Name:
(Last) (First) (Middle)
photo
Sex: Age: Civil Status:

Date of Birth: Place of Birth:

(dd/Mo/Yr)

Residence Address: Tel. No.:

Mailing Address:

Present Position / Item:

Assigned / detailed at: Division: Section / Service: Agency:

Status of employment: Number of years in service: Office Tel. no:

A. EDUCATIONAL ATTAINMENT (pls. present original college transcript of records and provide xerox copy)

School/University/College/Institute Course/Degree obtained Date of Attendance

Elem.
High
School
College

Voca-
tional

B. TRAINING (SEMINARS, WORKSHOPS, FELLOWSHIPS & SPECIAL STUDIES COMPLETED)

Title of Training Date of Attendance Conducted by Training
Hrs.

(Continue on separate sheet if necessary)

C. ELLIGIBILITY (IES) (Career Service/Professional Board/Bar Exam)

Title of Exam Place of Exam Date Taken Rating %

D. RECORD OF SERVICE
From To Position Office Status of appointment

(Continue on separate sheet if necessary)

1. Are you willing to accept assignment to any PAGASA field station?

If yes, state your priorities:

2. Are you related within the 3 rd degree of affinity or consanguinity to any PAGASA personnel or to the person who has
direct supervision over you in the office or Department you are appointed to be? ____________________

If so, to whom?

3. Have you ever been convicted for violating any law, decree, ordinance or regulations, by any court or tribunal?
__________________

4. Have you ever been convicted for any breach of infraction by a military, naval or constabulary tribunal or authority,
or found guilty of an administrative offense? _________________

If yes, give particulars:

F. Personal References
Name Address

I certify that the foregoing statements are true and complete to the best of my knowledge and understand that any
false statement is sufficient to cause rejection of the application.

Date accomplished:
Signature over printed name

NOMINATION

Date:

I hereby nominate Mr/Ms to attend the

(Title of the Training Course)

The purpose/objective of which is relevant to his/her actual/ proposed responsibilities.

Recommending Approval:

(Section Chief)
APPROVE/DISAPPROVE

(Division Chief)

“tracking the sky . . . helping the country”