Cs form100rev nov2012
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This document is an application form for the Civil Service Examination in the Philippines. It requests information such as the applicant's personal details, educational background, employment history, and eligibility for the exam. The form provides instructions on the admission and application requirements, such as having an original valid ID for verification and paying the examination fee. It also specifies photo specifications that must accompany the application.
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Cs form100rev nov2012
- 1. CS FORM No. 100 (Revised November 2012) . This Form is NOT for sale. Reproduction is allowed. APPLICATION NO. _______________ APPLICATION FOR CIVIL SERVICE EXAMINATION For Processor ONLY CSC Regional Office To be filled-out by Applicant Examination Applied For : Paper-and-Pencil Test (PPT) Mode Level Date of Examination (mm/dd/yyyy) CSE-Professional Others Place of Examination (see Specifications at the back) CSE-SubProfessional Last Examination Taken : (for Career Service Examination Applicants only) CSE-SubProfessional CSE-Professional ______________________________ Verified against: DIBAR E-Retakers Date of Exam (mm/dd/yyyy) Instructions : READ ADMISSION AND APPLICATION REQUIREMENTS AT THE BACK PAGE. DO NOT APPLY IF NOT QUALIFIED. Fill in all the required information. DO NOT leave an item blank. If item is not applicable, indicate N/A. All applications must be filed PERSONALLY by applicant. NAME ID PHOTO ______________________________ Computer-Assisted Test (CAT) (Last Name) (First Name) OEVS CSID NO. (if any) (Ext. Name, i.e. Jr./Sr., if any) (M.I.) (Middle Name) A. FACTS OF BIRTH AGE DATE OF BIRTH (mm/dd/yyyy) CITIZENSHIP SEX Male PLACE OF BIRTH (City / Municipality) (Province) (Country) Female MOTHERS MAIDEN NAME ( Last Name) (Middle Name) (First Name) B. CURRENT DEMOGRAPHIC DATA PERMANENT/MAILING ADDRESS (Room / Floor / Unit No. / Bldg. Name) (Barangay) HEIGHT (meters) (House / Lot / Block / Phase No.) (City / Municipality) WEIGHT (kg) CIVIL STATUS Single . MOBILE NUMBER (Required) (Street Name) (Province) Married Widowed (Subdivision) (Country) Legally Separated Others ______________ Annulled TELEPHONE NUMBER/S (include Area Code) ZIP CODE E-MAIL ADDRESS (Required) C. EDUCATIONAL BACKGROUND If Not Graduated Level of Education Course/Degree Title Name of School & Address (City/Municipality & Province) Year of Last Attendance Highest Grade/ Level/ Units Earned If Graduated Year Graduated Academic Honors Received Doctorate Masters College Vocational/Technical High School Elementary D. INFORMATION ON GOVERNMENT EXAMINATIONS PASSED / CIVIL SERVICE ELIGIBILITY Title of Examination Passed / Title of Eligibility Granted Rating Obtained Date of Examination / Date Eligibility Granted Place of Examination __________________________________________ Date Accomplished ____________________________________________________________________ Signature over Printed Name of Applicant DO NOT FILL-OUT THE SHADED PORTION. (FOR PROCESSOR ONLY). Date: ________________ O.R. No. _____________ Identification/Other Documents Presented: _______________________________________ Details: ______________________________________ DISAPPROVED ACTION TAKEN: APPROVED Amount: _____________ Reason: _________________________________ _____________________ ________________________________________ Signature over Printed Name of Processor / Date Name of Collecting Officer APPLICATION RECEIPT Date: ________________ O.R. No. _____________ Examination Applied For: Amount: _____________ DATE: _________________________________ _____________________ Name of Collecting Officer PPT CAT Professional TIME: ____________ ____________________________________________ Signature over Printed Name of Processor APPLICATION NO. __________________________ SubProfessional Others _________ PLACE: ____________________________ ____________________________________ Date Received / Processed To be filled-out by Applicant Applicants Name: _________________________________________________________________________________________________________ First Name Sex: Male Female Date of Birth (mm/dd/yyyy): MI Last Name Ext. Name (i.e. Jr./Sr., if any) Signature: ____________________________ WARNING: The Civil Service Commission uses a highly reliable system to detect cheats. Any form of cheating in any civil service examination shall be considered a violation of Republic Act No. 9416 (Anti-Cheating Law), and any person found guilty shall be administratively and criminally liable. ~ Please continue at the Back Page ~ ID PHOTO (see Specifications at the back)
- 2. E. PRESENT EMPLOYMENT Private Government Non-government Organization Agency/Office Address Unemployed Self-Employed Position/Job Title No. of Years in Present Position/Job Status of Appointment/ Employment F. OTHER INFORMATION 1. Have you ever been dismissed from the military/civil service for cause, or found guilty of crime involving moral turpitude, or of infamous, disgraceful or immoral conduct, drunkenness or addiction to drugs, or of offense relative to or in connection with the conduct of a civil service examination? YES NO IF YES, attach copy/ies of decision/s. 2. Pursuant to (a) Indigenous Peoples Act (RA 8371) and (b) Magna Carta for Disabled Persons (RA 7277, as amended), please answer the following items: a) Are you a member of any indigenous group? YES NO If YES, please specify: __________________________________________ b) Are you a person with disability? YES NO If YES, please specify: __________________________________________ G. DECLARATION I declare under oath that I personally accomplished this application form, and I hereby certify that the information given are true, correct, and complete statements pursuant to the provisions of pertinent laws, rules, and regulations of the Republic of the Philippines. Further, I understand that the acceptance and approval of my application for the examination is based on the aforestated information. I therefore agree that, in case a post-verification yields information contrary to what is declared, my application shall be disapproved, and my payment forfeited. I further agree that any misrepresentation made in this document may cause the invalidation of the result of this examination and/or the filing of administrative/criminal case/s against me. In addition, I agree to undergo a validating examination in case my test results shall be found statistically improbable. Failure on my part to take the validating examination shall cause the cancellation of my test results. Note: Spaces for Signature/Printed Name and Right Thumbmark of applicant should be left blank. These shall only be accomplished in the presence of the Administering Officer/CSC Processor. _________________________________________________________ Signature over Printed Name of Applicant Right Thumbmark Subscribed and sworn to before me this ________ day of ______________________________, 20 ______. ________________________________________________ Signature over Printed Name of Administering Officer ____________________________ Office / Position ADMISSION REQUIREMENTS 1. 2. 3. 4. 5. 6. APPLICATION REQUIREMENTS 1. Must be 18 years of age on the date of filing of application; 2. Must be Filipino citizen; Must be of good moral character; Must have not been convicted by final judgment of an offense or crime involving moral turpitude, or disgraceful or immoral conduct, dishonesty, examination irregularity, drunkenness or addiction to drugs; Must have not been dishonorably discharged from military service or dismissed for cause from any civilian positions in the government; and For Career Service Examination applicants, must have not taken the same level of Career Service Examination in less than three (3) months. 3. NOTE: Applicants with pending administrative and/or criminal cases may take the examination and shall be conferred the eligibility if they successfully pass the same. However, this is without prejudice to the outcome of their pending cases. If 4. they are found guilty of grave offenses, their eligibility shall be forfeited based on the penalties stated in the decision and pursuant to Section 52 (a) of the Revised Rules on 5. Administrative Cases in the Civil Service. Fully accomplished application form (CS Form No. 100 Revised 2012); Four (4) copies of identical pictures with specifications, as follows: taken within the last three (3) months prior to filing of application Philippine passport picture size (4.5 cm x 3.5 cm or 1.78 x 1.38) colored, with white background and printed on quality photo paper in standard close-up shot (from shoulder level up with the head and face occupying at least 80% of the picture and with the name tag positioned at approximately 1 inch below the chin) in bare face (without eyeglasses or any accessories that may cover the facial features and showing left and right ears taken in full-face view directly facing the camera, with neutral facial expression and both eyes open with full and handwritten (not computer-generated) name tag in the format: First Name, Middle Initial, Last Name, and Extension Name, if any, and signature over the printed name Original and photocopy of any valid ID containing applicants clear picture, date of birth, signature, and signature of the authorized head of the issuing agency such as Drivers License, SSS ID, GSIS ID, Philhealth ID, current Company/Office ID, current School ID, Postal ID, BIR ID, Barangay ID, Voters ID, Valid Passport, or Police Clearance (Note: Any other ID not included in the list shall NOT be accepted) For applicants without data on their date of birth in their valid ID, original and photocopy of NSO-issued Birth Certificate or Birth Certificate authenticated/issued by the Local Civil Registrar (LCR) Examination fee of Php500 for the CSE-PPT, or Php600 for the CSE-CAT. For fees of other examinations, please see related Examination Announcement. REMINDERS A. FOR APPLICANTS OF CSE PAPER-AND-PENCIL TEST (CSE-PPT) Qualified applicants shall be notified of their school assignment through an Application Receipt or a Notice of School Assignment (NOSA). They can also use the Online Notice of School Assignment (ONSA) found in the CSC Website (www.csc.gov.ph) to get a print-out of their NOSA. If applicants still do not know their school assignment or cannot get a copy of their NOSA via internet one (1) week before the examination day, they should visit or call the Regional Office or Field Office where they filed their application to inquire about their school assignment. Failure to come on your scheduled examination will mean forfeiture of examination fee and slot. B. FOR APPLICANTS OF CSE COMPUTER-ASSISTED TEST (CSE-CAT) Failure to come on your scheduled examination will mean forfeiture of examination fee and slot. IMPORTANT: All personal belongings including cellular phones, calculators, books, and all other electronic and printed materials must be surrendered to the Room Examiners. Firearms, if any, must also be surrendered to the security guard/designated firearm custodian at the entrance gate of the testing center. Proper attire should be worn on filing of application form and on examination day. (e.g. NOT IN SLEEVELESS SHIRT/BLOUSE, OR IN SHORT PANTS, OR IN SLIPPERS) BRING THE FOLLOWING ON EX AMINATION D AY 1. 2. This Application Receipt or Notice of School Assignment Same valid I.D. presented at the time of filing of application (NO I.D., NO EXAM ) 3. 4. One (1) blue or black ballpen Lead pencil/s No. 1 or 2 and eraser/s