IV.

CIVIL SERVICE ELIGIBILITY

27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

NURSING LICENSURE EXAMINATION 78.20% 12/01/2005 UNIVERSITY OF THE EAST, METRO MANILA 0392274 10/18/2020

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
INCLUSIVE DATES SALARY/ JOB/ PAY
28.
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/
APPOINTMENT
(Y/ N)
From To INCREMENT

06/01/2009 03/31/2015 CLINICAL INSTRUCTOR BRENT HOSPITAL AND COLLEGES INCORPORATED 8,000PHP NA REGULAR N

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 7,2022

CS FORM 212 (Revised 2017), Page 2 of 4