REPUBLIC OF THE PHILIPPINES )

_________________________ ) S.S.

AFFIDAVIT OF INFORMED CONSENT AND WAIVER

I, JULIUOS WARREN G. RUEDA, of legal age, single/married, Filipino,
with residence and postal address at Brgy. Rawis, Hinabangan, Samar, after
having been duly sworn to in accordance with law, hereby depose and state that:

1. I voluntarily applied for a vacant position of Administrative Assistant

III (Computer Operator II), with Salary Grade (SG) 9 and work
station at Municipal Planning & Development Coordinator, LGU-
Hinabangan, posted on August 7, 2020 at CSC Bulletin of Vacant
Positions;

2. I hereby waive and acknowledge the status of my appointment for

Administrative Assistant III (Computer Operator II) position from
PERMANENT to TEMPORARY.

3. I hereby waive my right to privacy under Republic Act No. 10173 (Data
Privacy Act of 2012) and pertinent laws and consequently, I will not file
case/s against any official of the LGU, CSC and other government
agency/ies for unintentional leak or disclosure to any party/ies or such
act/s, which may constitute violation/s of my rights relative to my
application and documents thereof, committed in good faith, in the
discharge of their duties and functions; and

4. This affidavit is voluntarily executed in order to attest to the truthfulness

of the foregoing narration of facts for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I am affixing my signature this 29th day of

October 2020 in LGU- Hinabangan, Hinabangan, Samar.

______________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this ______ day of

____________ 2020 at _________________________ Philippines. Affiant
exhibited to me his/her valid government issued Identification (ID) with number
_____________ and issued on _______________________ at
_________________________________.

Doc. No. __________;

Page No.__________;
Book No.__________;
Series of __________.