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Distance Learning Program Application Form (CSC Philippines)

Application Form for Distance Learning Program of the Civil Service Commission (CSC) Philippines. Rules of Conduct and Ethical Behavior in the Civil Service.

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Andy Soriano
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© Attribution Non-Commercial (BY-NC)
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8K views2 pages

Distance Learning Program Application Form (CSC Philippines)

Application Form for Distance Learning Program of the Civil Service Commission (CSC) Philippines. Rules of Conduct and Ethical Behavior in the Civil Service.

Uploaded by

Andy Soriano
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES

CIVIL SERVICE COMMISSION


QUEZON CITY
Recent
photo

THIS FORM IS NOT FOR SALE


REPRODUCTION IS ALLOWED
APPLICATION FOR
DISTANCE LEARNING PROGRAM

APPLICATION NO:______________
DATE OF EXAM:________________

NOTE:
ACCEPTANCE OF APPLICATION
A FIRST COME FIRST SERVED BASIS
1. APPLICANTS NAME (COMPLETE)
_______________________________________________________________________________________________
______
(SURNAME)
(GIVEN NAME)
(MIDDLE NAME)
_______________________________________________________________________________________________
______
2. MAILING ADDRESS (COMPLETE)
3. CIVIL STATUS _________________ 4. DATE OF BIRTH __________________ 5. SEX
__________________
6. PLACE OF BIRTH _________________ 7. CITIZENSHIP: _______________ 8. TELEPHONE NUMBER
______________
9. EDUCATION (FILL IN APPROPRIATE COLUMN)
a. IF COLLEGE GRADUATE

b. IF VOCL.

GRADUATE/UNDERGRADUATE
DEGREE FINISHED
_____________________________
MAJOR FIELD OF STUDY
________________________
DATE GRADUATED
_____________________________
SCHOOL GRADUATED
__________________________
SCHOOL ADDRESS
_____________________________

10. GOVERNMENT SERVICE RECORD


POSITION

HIGHEST YEAR IN COLLEGE COMPLETED


______________
COURSE
___________________________________________
NO. OF UNITS EARNED
______________________________
INCLUSIVE YEAR ATTENDED
_________________________
SCHOOL ATTENDED
________________________________
SCHOOL ADDRESS
_________________________________

STATUS

11. CIVIL SERVICE/BOARD/BAR EXAMINATION PASSED


RATING
DATE OF
EXAMINATION

OFFICE ADDRESS

PLACE OF
EXAMINATION

12. HAVE YOU EVER BEEN DISMISSED FROM ANY EMPLOYMENT, FORCED TO RESIGN OR
OTHERWISE DISCIPLINES AS A RESULT OF ADMINISTRATIVE CASE OR CONVICTED ON ANY
VIOLATION OF LAW, ORDINANCE OR REGULATION BEFORE ANY ONE BEFORE ANY CIVIL COURT
AND/OR MILITARY TRIBUNAL?
YES
NO

IF YES, ATTACH COPIES OF DECISIONS

I DECLARE UNDER T PENALTIES OF PERJURY THAT THE APPLICATION HAS BEEN ACCOMPLISHED IN
GOOD FAITH, VERIFIED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A TRUE,

CORRECT AND COMPLETE STATEMENT PURSUANT TO THE PROVISIONS OF THE PERTINENT LAWS,
RULES AND REGULATIONS OF THE REPUBLIC OF THE PHILIPPINES.
__________________________________
SIGNATURE OF APPLICANT

13. DO NOT FILL THIS PORTION


ACTION TAKEN: APPROVED ____ DISAPPROVED ____
___________________
OR NUMBER ________________
DATE ______________________

DATE ____________

SIGNATURE

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