ROSTER OF BENEFICIARIES/AVAILEE

(RA 11261 - FIRST TIME JOBSEEKERS ACT)

BARANGAY _______________ ZONE____________
GAMU, ISABELA

SEX/
NAME OF BENEFICIARY/AVAILEE DATE OF BIRTH EDUCATIONAL LEVEL
GENDER
AGE
Elementary/
Last Name First Name Middle Name Month Date Year M F College Course OSY
High School

Note: This form shall be accomplished by the barangay or concerned agency to be submitted to DILG through City/Municipality or DICT)

Prepared by: Noted by:

_______________________________ _______________________________
Name, Designation & Signature Name, Designation & Signature

_______________________________ _______________________________
Date Date