Barangay Reporting Form 1 - ROSTER

ROSTER OF BENEFICIARIES/AVAILEES
(RA 11261 -FIRST TIME JOBSEEKERS ACT)
BRGY. ___, ZONE ___, City of ________
For the month of __________, year ___________.

NAME OF BENEFICIARY/AVAILEE DATE OF BIRTH SEX

HIGHEST
MARITAL
AGE EDUCATIONAL PWD
STATUS
Barangay Certificate
Last Name First Name
Middle
Suffix Month Date Year Male Female ATTAINMENT
Number Name

Notes:
1. This form shall be accomplished by the barangay to be submitted to their
respective City/Municipality PESO. A copy should also be given to their respective
DILG Field Office.
Prepared by: Noted by:

______________________________ ____________________________________
Name, Designation & Signature Punongbarangay/Authorized Representative and Position
 FTJAA BARANGAY REPORTING FORM 1 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by the barangay chairman or the barangay secretary. In the absence of both, an authorized barangay official may fill up the form.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. See sample below.

Juan Dela Cruz

JUAN DELA CRUZ, Barangay Secretary

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within three (3) working days after the reference month and year.

4. Barangay number/name, zone number, and city - The blanks for the barangay number/name, the zone number, and city should be filled up accurately.
BRGY. 763 ZONE 83

CITY OF MANILA

5. Month and year - The reference month and accurate year shall be indicated in the form.

6. Barangay Certificate Number - Each first

BARANGAY time jobseeker shall be given a unique Barangay Certificate Number. The Barangay Certificate Number shall appear as follows:
CERTIFICATE
NUMBER
1. 11261-763-83-001
2. 11261-763-83-002
7. Name of beneficiary/availee - The full name of the beneficiary/availee shall appear in the form as follows:
LAST FIRST MIDDLE
NAME NAME NAME SUFFIX
REYES JOSE P. JR.
8. Age - The accurate age of the first time jobseeker shall be provided in years. The minimum age of those who may avail of the services under this act is 18 years old. Those who
are under 18 years of age may avail of the services under this act provided that the Oath of Undertaking indicates that parental consent has been given. The Oath must also
be signed by either parent, or of a guardian, whichever is applicable.

9. Date of birth - The date of birth shall appear in the form in numerical format, as follows:
MONTH DATE YEAR
12 24 1997
10. Sex - An "x" shall be placed under the accurate sex of the first time jobseeker.

11. Marital Status - Indicate if the applicant is single, married, a single parent, widowed, or separated.
12. Highest Educational Attainment - Indicate one of the following: Elementary, High School, Senior High School, College, Graduate School, Technical-Vocational Course, or Out of School Youth

13. Person With Disability (PWD) - An "x" shall be placed under the column in the event that the applicant is a PWD.

14. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to their
respective City/Municipality PESO within three (3) working days after each reference month.

IMPORTANT NOTE: The step by step process of accomplishing the forms as well as its submission shall be observed pending the development of a central FTJAA Database.
 Barangay Reporting Form 2
- SUMMARY
RA 11261 -FIRST TIME JOBSEEKERS ACT MONITORING FORM
MONTHLY SUMMARY OF AVAILEES/BENEFICIARIES
Barangay ___ Zone ___ - CITY OF _______
(MONTH) (YEAR)

SEX EDUCATIONAL LEVEL

NO. OF
MONTH BENEFICIARIES/
AVAILEES Technical- Out of
Senior High Graduate
M F Elementary High School College Vocational School
School School
Course Youth

JAN - - - - - -

FEB - - - - - -

MAR - - - - - -

APR - - - - - -

MAY - - - - - -

JUN - - - - - -

JUL 26 11 15 5 9 2

AUG
SEP
OCT
NOV
DEC

TOTAL Err:522 Err:522 Err:522 Err:522 Err:522 Err:522

Notes:

1. This form shall be accomplished by the barangay to be submitted to their respective City/Municipality PESO. A copy
should also submitted to their respective DILG Field Office.

Prepared by: Reviewed and approved by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature

________________________________ ____________________________________

Date Date
 FTJAA BARANGAY REPORTING FORM 2 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by the barangay chairman or the barangay secretary. In the absence of both, an authorized barangay official may fill up the form.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. See sample below.
Prepared by: Noted by:
Juan Dela Cruz
JUAN DELA CRUZ, Barangay Secretary
Maria Perez
MARIA PEREZ, Barangay Chairman

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within three (3) working days after the reference month and year.

4. Barangay number/name, zone number, and city - The blanks for the barangay number/name, the zone number, and city should be filled up accurately.
BRGY. 763 ZONE 83, CITY OF MANILA

5. Month and year - The reference month and accurate year shall be indicated in the form.

6. Number of Beneficiaries - This field shall be answered based on the total number of beneficiaries during the reference month.

7. Sex - The total number indicated in fields for male and female shall be equal to the total number of beneficiaries.

8. Educational Level - The total number indicated in fields for elementary, high school, senior high school, college, technical vocational graduate, graduate, and out of school youth shall be equal to
the total number of beneficiaries.

9. Total - The total number of beneficiaries per field must be updated monthly based on the report of each barangay.

10. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to their
respective City/Municipality PESO within three (3) working days after each reference month.
 City/Municipality Reporting Form 1 -
ROSTER
ROSTER OF BENEFICIARIES/AVAILEES
(RA 11261 -FIRST TIME JOBSEEKERS ACT)
CITY/MUNICIPALITY:_________________
For the month of __________, year ___________.

NAME OF BENEFICIARY/AVAILEE DATE OF BIRTH SEX

HIGHEST
MARITAL
AGE EDUCATIONAL PWD
STATUS
Barangay Certificate
Last Name First Name
Middle
Suffix Month Date Year Male Female ATTAINMENT
Number Name

Notes:

1. This form shall be accomplished by the City/Municipality PESO, to be submitted to

their respective Provincial PESO, within ten (10) working days from the reference
month.

Prepared by: Noted by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature
 FTJAA CITY/MUNICIPALITY REPORTING FORM 1 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by an authorized officer of the city or municipality.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. See sample below.

Juan Dela Cruz

JUAN DELA CRUZ, Administrative Officer IV

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within 10 working days after the submission of barangays from the reference month and year.

4. City or Municipality - The fields for city/municipality must be filled up accordingly, as follows.
CITY/MUNICIPALITY: CITY OF MANILA

5. Month and year - The reference month and accurate year shall be indicated in the form.

6. Barangay Certificate Number - Each first time jobseeker shall be given a unique Barangay Certificate Number which must be reflected in the City/Municipality roster. The Barangay

Certificate Number shall appear as follows: CERTIFICATE

BARANGAY
NUMBER
1. 11261-763-83-001
2. 11261-763-83-002
7. Name of beneficiary/availee - The full name of the beneficiary/availee shall appear in the form as follows:
LAST FIRST MIDDLE
NAME NAME NAME SUFFIX
REYES JOSE P. JR.
8. Age - The accurate age of the first time jobseeker shall be provided in years. The minimum age of those who may avail of the services under this act is 18 years old. Those who
are under 18 years of age may avail of the services under this act provided that the Oath of Undertaking indicates that parental consent has been given. The Oath must also
be signed by either parent, or of a guardian, whichever is applicable.

9. Date of birth - The date of birth shall appear in the form in numerical format, as follows:
MONTH DATE YEAR
12 24 1997
10. Sex - An "x" shall be placed under the accurate sex of the first time jobseeker.

11. Marital Status - Indicate if the applicant is single, married, a single parent, widowed, or separated.
12. Highest Educational Attainment - Indicate one of the following: Elementary, High School, Senior High School, College, Graduate School, Technical-Vocational Course, or Out of School Youth

13. Person With Disability (PWD) - An "x" shall be placed under the column in the event that the applicant is a PWD.

14. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to their
respective Provincial PESO within ten (10) working days after each reference month.

IMPORTANT NOTE: The step by step process of accomplishing the forms as well as its submission shall be observed pending the development of a central FTJAA Database.
 CITY/MUNICIPALITY REPORTING
FORM 2 - SUMMARY
[CITY/MUNICIPALITY]
RA 11261 - FIRST TIME JOBSEEKERS ACT MONITORING FORM
MONTHLY SUMMARY OF AVAILEES/BENEFICIARIES
(MONTH) (YEAR)

NO. OF
SEX/ GENDER EDUCATIONAL LEVEL
BENEFICIARIES/
BARANGAY Technical- Out of
Graduate
M F Elementary High School Senior High School College Vocational School
AVAILEES School
Course Youth
BRGY. 1 11 5 6 2 0 2 7
BRGY. 2 8 4 4 0 0 2 3
BRGY. 3 0 0 0 0 0 0 0
POBLACION 7 4 3 2 1 4 0

TOTAL Err:522 Err:522 Err:522 Err:522 Err:522 Err:522

* - if data is available
** - if data is available

Prepared by: Reviewed and approved by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature

________________________________ ____________________________________

Date Date
 FTJAACITY/MUNICIPALITY REPORTING FORM 2 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by any authorized personnel of the LGU in charge of or engaged in providing pre-employment services.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. The form shall be
noted by the supervisor or the division chief of the person who prepared the report. See sample below.
Prepared Noted by:
Juan Dela Cruz
JUAN DELA CRUZ, Labor and Employment Officer I Maria Perez
MARIA PEREZ, Division Chief

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within ten (10) working days after the submission of barangays from reference month and year.
4. LGU Name- The name of the agency shall appear spelled out and in acronym, as follows:
LGU NAME: MANILA
5. Month and year - The reference month and accurate year shall be indicated in the form.
6. Number of Beneficiaries - This field shall be answered based on the total number of beneficiaries during the reference month.
7. Sex - The total number indicated in fields for male and female shall be equal to the total number of beneficiaries.
8. Educational Level - The total number indicated in fields for elementary, high school, senior high school, college, technical vocational graduate, graduate, and out of school youth shall be equal to
the total number of beneficiaries.
9. Total - The total number of beneficiaries per field must be updated monthly based on the report of each agency.
10. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to their
respective Provincial PESO within ten (10) working days after each reference month.
 HUC/ICC Reporting Form 1 - ROSTER

ROSTER OF BENEFICIARIES/AVAILEES
(RA 11261 -FIRST TIME JOBSEEKERS ACT)
HUC/ICC:_________________
For the month of __________, year ___________.

NAME OF BENEFICIARY/AVAILEE DATE OF BIRTH SEX

HIGHEST
MARITAL
AGE EDUCATIONAL PWD
STATUS
Barangay Certificate
Last Name First Name
Middle
Suffix Month Date Year Male Female ATTAINMENT
Number Name

Notes:

1. This form shall be accomplished by the HUC/ICC PESO, to be submitted to the

Department of Labor and Employment thru the Bureau of Local Employment, within
ten (10) working days from submission of barangays from reference month.

Prepared by: Noted by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature
 FTJAA HUC/ICC REPORTING FORM 1 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by an authorized officer of the city or municipality.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. See sample below.

Juan Dela Cruz

JUAN DELA CRUZ, Administrative Officer IV

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within 10 working days after the reference month and year.

4. HUC/ICC - The field for city must be filled up accordingly, as follows.

CITY: CITY OF MANILA

5. Month and year - The reference month and accurate year shall be indicated in the form.

6. Barangay Certificate Number - Each first time jobseeker shall be given a unique Barangay Certificate Number which must be reflected in the City/Municipality roster. The Barangay
Certificate Number shall appear as follows: CERTIFICATE
BARANGAY
NUMBER
1. 11261-763-83-001
2. 11261-763-83-002
7. Name of beneficiary/availee - The full name of the beneficiary/availee shall appear in the form as follows:
LAST FIRST MIDDLE
NAME NAME NAME SUFFIX
REYES JOSE P. JR.
8. Age - The accurate age of the first time jobseeker shall be provided in years. The minimum age of those who may avail of the services under this act is 18 years old. Those who
are under 18 years of age may avail of the services under this act provided that the Oath of Undertaking indicates that parental consent has been given. The Oath must also
be signed by either parent, or of a guardian, whichever is applicable.

9. Date of birth - The date of birth shall appear in the form in numerical format, as follows:
MONTH DATE YEAR
12 24 1997
10. Sex - An "x" shall be placed under the accurate sex of the first time jobseeker.

11. Marital Status - Indicate if the applicant is single, married, a single parent, widowed, or separated.
12. Highest Educational Attainment - Indicate one of the following: Elementary, High School, Senior High School, College, Graduate School, Technical-Vocational Course, or Out of School Youth

13. Person With Disability (PWD) - An "x" shall be placed under the column in the event that the applicant is a PWD.

14. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to the
Department of Labor and Employment (DOLE) through the electronic mail addres ftjaa.dole@gmail.com within ten (10) working days after each reference month.

IMPORTANT NOTE: The step by step process of accomplishing the forms as well as its submission shall be observed pending the development of a central FTJAA Database.
 HUC/ICC Reporting Form 2 -
SUMMARY
[HUC/ICC]
RA 11261 - FIRST TIME JOBSEEKERS ACT MONITORING FORM
MONTHLY SUMMARY OF AVAILEES/BENEFICIARIES
(MONTH) (YEAR)

NO. OF
SEX/ GENDER EDUCATIONAL LEVEL
BENEFICIARIES/
BARANGAY Technical- Out of
Graduate
M F Elementary High School Senior High School College Vocational School
AVAILEES School
Course Youth
BRGY. 1 11 5 6 2 0 2 7
BRGY. 2 8 4 4 0 0 2 3
BRGY. 3 0 0 0 0 0 0 0
POBLACION 7 4 3 2 1 4 0

TOTAL Err:522 Err:522 Err:522 Err:522 Err:522 Err:522

* - if data is available
** - if data is available

Prepared by: Reviewed and approved by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature

________________________________ ____________________________________

Date Date
 FTJAA HUC/ICC REPORTING FORM 2 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by any authorized personnel of the LGU in charge of or engaged in providing pre-employment services.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. The form shall be
noted by the supervisor or the division chief of the person who prepared the report. See sample below.
Prepared Noted by:
Juan Dela Cruz
JUAN DELA CRUZ, Labor and Employment Officer I Maria Perez
MARIA PEREZ, Division Chief

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within 10 working days after the reference month and year.
4. HUC/ICC- The name of the city shall appear, as follows:
LGU NAME: MANILA
5. Month and year - The reference month and accurate year shall be indicated in the form.
6. Number of Beneficiaries - This field shall be answered based on the total number of beneficiaries during the reference month.
7. Sex - The total number indicated in fields for male and female shall be equal to the total number of beneficiaries.
8. Educational Level - The total number indicated in fields for elementary, high school, senior high school, college, technical vocational graduate, graduate, and out of school youth shall be equal to
the total number of beneficiaries.
9. Total - The total number of beneficiaries per field must be updated monthly based on the report of each agency.
10. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to their
respective Provincial PESO within ten (10) working days after each reference month.
 Provincial Form -
SUMMARY
[PROVINCE]
RA 11261 - FIRST TIME JOBSEEKERS ACT MONITORING FORM
MONTHLY SUMMARY OF AVAILEES/BENEFICIARIES
(MONTH) (YEAR)

SEX /
NO. OF BRGYS. EDUCATIONAL LEVEL
NO. OF GENDER
CITY / MUNICIPALITY WITH
AVAILEES Graduate
Technical- Out of
AVAILEES M F Elementary High School Senior High School College Vocational School
School
Course Youth
Tagaytay 9 26 11 15 5 9 2

Imus 4 11 9 2 3 0 1 7

Naic 5 20 6 14 1 5 7 2

Bacoor 4 17 10 7 0 3 5 5

TOTAL 74 36 38 9 17 15 14

* - if data is available
** - if data is available

Prepared by: Reviewed and approved by:

______________________________ ____________________________________
Name, Designation & Signature PESO Manager/Authorized Representative and Position

________________________________ ____________________________________

Date Date
 FTJAA PROVINCIAL REPORTING FORM - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by any authorized personnel of the LGU in charge of or engaged in providing pre-employment services.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. The form shall be
noted by the supervisor or the division chief of the person who prepared the report. See sample below.
Prepared Noted by:
Juan Dela Cruz
JUAN DELA CRUZ, Labor and Employment Officer I Maria Perez
MARIA PEREZ, Division Chief

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within 10 working days after the reference month and year.
4. Province- The name of the province shall appear , as follows:
PROVINCE NAME: CAVITE
5. Month and year - The reference month and accurate year shall be indicated in the form.
6. City/Municipality - This field should indicate the cities or municipalities under a province.
7. Number of Barangays with Availees - This field shall be answered based on the total number of barangays that submitted reports during the reference month.
8. Sex - The total number indicated in fields for male and female shall be equal to the total number of beneficiaries.
9. Educational Level - The total number indicated in fields for elementary, high school, senior high school, college, technical vocational graduate, graduate, and out of school youth shall be equal to
the total number of beneficiaries.
10. Total - The total number of beneficiaries per field must be updated monthly based on the report of each agency.
11. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to the
Department of Labor and Employment via electronic mail at ftjaa.dole@gmail.com within 10 working days after each reference month.
 Agency Reporting Form 1 -
ROSTER
ROSTER OF BENEFICIARIES/AVAILEES
(RA 11261 -FIRST TIME JOBSEEKERS ACT)
AGENCY NAME: _____________
For the month of __________, year ___________.

MARITAL HIGHEST
NAME OF BENEFICIARY/AVAILEE DATE OF BIRTH SEX STATUS EDUCATIONAL
ATTAINMENT
1 - Single
2 - Married 1 - Elementary
3 - Single Parent 2 - High School
AGE 3 - Sr High School PWD
Barangay 4 - Widowed 4 - College
Middle 5 - Separated
Certificate Last Name First Name Suffix Month Date Year Male Female 5 - Graduate School
Name 6 - Technical/Vocational Course
Number 7 - Out of School Youth

Note: This form shall be accomplished by the concerned agency to be submitted to DOLE.

Prepared by: Noted by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature

______________________________ ____________________________________
Date Date
 FTJAA AGENCY REPORTING FORM 1 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by any authorized personnel of the agency in charge of or engaged in providing pre-employment services.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. The form shall be

noted by the supervisor or the division chief of the person who prepared the report. See sample below.
Prepared by: Noted by:
Juan Dela Cruz Maria Perez
JUAN DELA CRUZ, Labor and Employment Officer I MARIA PEREZ, Division Chief

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within 10 working days after the reference month and year.
4. Agency name - The name of the agency shall appear spelled out and in acronym, as follows:
AGENCY NAME: National Bureau of Investigation (NBI)

5. Month and year - The reference month and accurate year shall be indicated in the form.
6. Barangay Certificate Number - Each first time jobseeker shall
BARANGAY be given a unique Barangay Certificate Number indicated in the barangay certificate to be presented, as follows:
CERTIFICATE
NUMBER
1. 11261-763-83-001
2. 11261-763-83-002
7. Name of beneficiary/availee - The full name of the beneficiary/availee shall appear in the form as follows:
FIRST MIDDLE
LAST NAME NAME NAME SUFFIX
REYES JOSE P. JR.
8. Age - The accurate age of the first time jobseeker shall be provided in years. The minimum age of those who may avail of the services under this act is 18 years old. Those who
are under 18 years of age may avail of the services under this act provided that the Oath of Undertaking indicates that parental consent has been given. The Oath must also
be signed by either parent, or of a guardian, whichever is applicable.
9. Date of birth - The date of birth shall appear in the form in numerical format, as follows:
MONTH DATE YEAR
12 24 1997
10. Sex - An "x" shall be placed under the accurate sex of the first time jobseeker.
11. Marital Status - Indicate the applicant's marital stauts through the following code/s:
MARITAL STATUS CODE
Single 1
Married 2
Single Parent 3
Widowed 4
Separated 5

12. Highest Educational Attainment - Indicate the applicant's highest educational attainment through the following codes:
HIGHEST EDUC. ATTAINMENT CODE
Elementary 1
High School 2
Senior High School 3
College 4
Graduate School 5
Technical/Vocational Course 6
Out of School Youth 7
13. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to the
Department of Labor and Employment via electronic mail at ftjaa.dole@gmail.com within 10 working days after each reference month.

IMPORTANT NOTE: The step by step process of accomplishing the forms as well as its submission shall be observed pending the development of a central FTJAA Database.
 Agency Reporting Form 2 -
SUMMARY
[AGENCY NAME]
RA 11261 - FIRST TIME JOBSEEKERS ACT MONITORING FORM
MONTHLY SUMMARY OF AVAILEES/BENEFICIARIES
(MONTH) (YEAR)

NO. OF SEX/ GENDER EDUCATIONAL LEVEL

MONTH BENEFICIARIES/ Technical- Out of
Graduate
AVAILEES M F Elementary High School Senior High School College Vocational School
School
Course Youth
JAN - - - - - -

FEB - - - - - -

MAR - - - - - -

APR - - - - - -

MAY - - - - - -

JUN - - - - - -

JUL 26 11 15 5 9 2

AUG
SEP
OCT
NOV
DEC

TOTAL Err:522 Err:522 Err:522 Err:522 Err:522 Err:522

* - if data is available
** - if data is available

Prepared by: Reviewed and approved by:

______________________________ ____________________________________
Name, Designation & Signature Name, Designation & Signature

________________________________ ____________________________________

Date Date
 FTJAA AGENCY REPORTING FORM 2 - GENERAL INSTRUCTIONS

1. Form - The form should be filled up by any authorized personnel of the agency in charge of or engaged in providing pre-employment services.
2. Prepared by/Noted by - The name, designation, and signature shall all be indicated. These fields cannot be filled up by the same person. The form shall be
noted by the supervisor or the division chief of the person who prepared the report. See sample below.
Prepared Noted by:
Juan Dela Cruz
JUAN DELA CRUZ, Labor and Employment Officer I Maria Perez
MARIA PEREZ, Division Chief

3. Date - The date below the prepared by and noted by fields must be the date the form was accomplished. It must be within 10 working days after the reference month and year.
4. Agency name - The name of the agency shall appear spelled out and in acronym, as follows:
AGENCY NAME: National Bureau of Investigation (NBI)

5. Month and year - The reference month and accurate year shall be indicated in the form.
6. Number of Beneficiaries - This field shall be answered based on the total number of beneficiaries during the reference month.
7. Sex - The total number indicated in fields for male and female shall be equal to the total number of beneficiaries.
8. Educational Level - The total number indicated in fields for elementary, high school, senior high school, college, technical vocational graduate, graduate, and out of school youth shall be equal to
the total number of beneficiaries.
9. Total - The total number of beneficiaries per field must be updated monthly based on the report of each agency.
10. Submission - The form shall be submitted strictly in excel form. No form in .pdf form or accomplished by hand shall be accepted. The form shall be submitted to the
Department of Labor and Employment via electronic mail at ftjaa.dole@gmail.com within 10 working days after each reference month.