NOMINATION FORM

SENIOR EXECUTIVE DEVELOPMENT PROGRAM

Instructions:
Please complete and mail or fax this form and your business card to:

COMMISSION ON AUDIT
PROFESSIONAL and INSTITUTIONAL
DEVELOPMENT SECTOR
Commonwealth Avenue, Quezon City, Philippines
Telefax Nos.: (632) 931-7847; (632) 951-0931
Please attach your business card here.
Please type or print responses.
A. PERSONAL DATA

Name: ______________________________________________________________________________
(SURNAME) (FIRST NAME) (M.I)

Date of Birth: _________________________________________ Sex:  Male  Female

Position Title and its Description: _________________________________________________________
Office Address: _______________________________________________________________________
Telephone: __________________ Facsimile: __________________ Email: _______________________

B. WORK EXPERIENCE

No. of years Brief Description of Responsibilities for the last two years:
with COA:

C. PROPOSAL FOR POLICY ANALYSIS / TITLE OF THE ACTION PROJECT (you may use additional sheet)

Recommending Approval: Approved:

________________________________ ________________________________
Cluster/Regional Director Assistant Commissioner/Regional Coordinator

_______________________ _______________________
(Date) (Date)

TO NOMINATE: ATTACHMENTS
 Fax the completed Nomination Form and attachments to (02)  Certification of Good Moral Character
9317847 / (02) 9510931  Certification that nominee has no pending administrative and/or
 Call the SEDP Secretariat at (02) 9317586 / (02) 9513534 legal cases
 Mail to: PROFESSIONAL DEVELOPMENT OFFICE  Certification that nominee is physically fit to perform classroom
COMMISSION ON AUDIT activities and physical exercises during the training
COMMONWEALTH AVENUE, QUEZON CITY

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Please submit complete nomination forms for your nominees. However, this does not mean all of them will be admitted to participate in the
PROGRAM. Acceptance to the Program will be subject to availability of slots. The total number of participants will be restricted to 30-35 per
class. Priority shall be given to nominees holding SA V positions or its equivalent and to contenders to promotion to higher positions.