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    Application Form: Professional Regulation Commission

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    Ruth Padayao Madrazo
    Ruth Madrazo is applying to retake the Professional Teacher licensure exam for Secondary (Filipino). She previously took the exam in March 2018 and September 2017 but failed both times. Her application details her educational background, including graduating from Saint Peter College-Balingasag with a Bachelor of Secondary Education degree in 2017. It also provides her personal information like name, address, citizenship, and contact details. If approved, her application will be processed and she will receive a Notice of Admission to retake the licensure exam scheduled for March 29, 2020.

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    Application Form: Professional Regulation Commission

    Uploaded by

    Ruth Padayao Madrazo
    105 views1 page
    Ruth Madrazo is applying to retake the Professional Teacher licensure exam for Secondary (Filipino). She previously took the exam in March 2018 and September 2017 but failed both times. Her application details her educational background, including graduating from Saint Peter College-Balingasag with a Bachelor of Secondary Education degree in 2017. It also provides her personal information like name, address, citizenship, and contact details. If approved, her application will be processed and she will receive a Notice of Admission to retake the licensure exam scheduled for March 29, 2020.

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    Ruth Madrazo is applying to retake the Professional Teacher licensure exam for Secondary (Filipino). She previously took the exam in March 2018 and September 2017 but failed both times. Her application details her educational background, including graduating from Saint Peter College-Balingasag with a Bachelor of Secondary Education degree in 2017. It also provides her personal information like name, address, citizenship, and contact details. If approved, her application will be processed and she will receive a Notice of Admission to retake the licensure exam scheduled for March 29, 2020.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    105 views1 page

    Application Form: Professional Regulation Commission

    Uploaded by

    Ruth Padayao Madrazo
    Ruth Madrazo is applying to retake the Professional Teacher licensure exam for Secondary (Filipino). She previously took the exam in March 2018 and September 2017 but failed both times. Her application details her educational background, including graduating from Saint Peter College-Balingasag with a Bachelor of Secondary Education degree in 2017. It also provides her personal information like name, address, citizenship, and contact details. If approved, her application will be processed and she will receive a Notice of Admission to retake the licensure exam scheduled for March 29, 2020.

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    of 1

    APPOINTMENT DATE: Dec 18, 2019 (01:00 PM TO 02:00 PM) - PRC Butuan

    Professional Regulation Commission

    APPLICATION FORM

    NOT FOR SALE (REPRODUCTION IS ALLOWED)


    REFERENCE NO: EX6FSSZ2PQ4Z
    Application No.
    OR: - | AMOUNT: PHP -
    -
    First Timer PROFESSIONAL TEACHER
    Name of Examination Secondary(Filipino)
    _________________________________
    X Repeater
    Conditioned Date of Examination March 29, 2020
    _________________________________
    Absent
    Place of Examination Cagayan de Oro
    _________________________________
    ________________
    12/03/2019
    Date(mm/dd/yy)
    NOTICE: All supporting documents shall become part of the records of the Commission. All applications must be filed
    PERSONALLY by the applicant.

    PART I-PERSONAL INFORMATION


    SUR NAME GIVEN NAME/S MIDDLE NAME
    MADRAZO RUTH PADAYAO
    Maiden Surname (for married female only)
    PADAYAO
    Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
    WATERFALL BALINGASAG MISAMIS ORIENTAL BALINGASAG, MISAMIS ORIENTAL
    Gender Citizenship Contact numbers (Landline & Mobile) E-mail Address
    Male X Female X Filipino Others______ 09976559582 [email protected]
    Civil Status Date of Birth(mm/dd/yy) Place of Birth (City/Town,Prov) RURBAN Code(Town/City,Prov)
    Single X Married Widow/er 12/16/1992 BALINGASAG, MISAMIS ORIENTAL 104302
    Spouse’s name & Citizenship Father’s Name & Citizenship Mother’s Name & Citizenship
    RONEL ETANG MADRAZO / FILIPINO TIMOTEO ALVARADO PADAYAO / FILIPINO LOURDES MILLAN PADAYAO / FILIPINO
    HAVE YOU EVER BEEN CHARGED AND CONVICTED BY FINAL JUDGEMENT BY ANY COURT OF JUSTICE/MILITARY TRIBUNAL OR
    ADMINISTRATIVE BODY? X No Yes (If yes, attach hereto a copy of the decision)
    PART II – EDUCATIONAL INFORMATION
    Name of School Address/Location of School PRC School code
    SAINT PETER COLLEGE-BALINGASAG BALINGASAG, MISAMIS ORIENTAL 0837
    Degree/Course Obtained PRC COURSE Code Date Graduated (mm/dd/yy) PRC Board Code
    BACHELOR OF SECONDARY EDUCATION 2017 03/29/2017 4000
    Date Graduated PRC SCHOOL
    Other Higher Educational Attainment Name of School Address/Location of School CODE
    (mm/dd/yy)

    PART III – PREVIOUS PRC LICENSURE EXAMINATION/S TAKEN (Last Three Exams)
    Place of Date Taken Result of Examination (pls check)
    Name of Examination Rating Exam No. Verified by
    Examination (mm/yy) Passed Failed Cond.
    PROFESSIONAL TEACHER - 03/2018 71.60 X
    PROFESSIONAL TEACHER - 09/2017 74.20 X

    Review School/Center: Self-Review School-Based Review Others (specify name) __________________________


    STATUS CODES (refer at the back) 1.) Examination Type (EXcode) 2.) Number of Times Taken 2

    I HEREBY CERTIFY that the information and/or ACTION TAKEN BY THE APPLICATION PROCESSOR
    statements in this application including the supporting ISSUANCE of the FOLOWING FORMS
    documents submitted in support thereof are all true and
    correct to my own knowledge, and that I am fully aware that NOTICE OF ADMISSION PERMANENT EXAMINATION &
    (NOA) REGISTRATION RECORD CARD (PERRC)
    any false information or statement in this application or in its
    attachments shall render me liable for criminal prosecution REMARKS ______________________________________________
    and/or administrative sanction. ______________________________________________________________________________

    PROCESSOR_____________________________ Date ___________


    RIGHT THUMBMARK _______________________ ____________________________________________________________
    Signature of Applicant ACTION TAKEN BY LEGAL OFFICER (if applicable)
    _______________________ REMARKS ______________________________________________
    Date Accomplished ______________________________________________________________________________

    LEGAL OFFICER __________________________ Date ___________


    Subscribed and sworn to before me this __________day of ____________________________________________________________
    _________20____at__________. Affiant applicant exhibited ACTION TAKEN BY THE BOARD
    to me his / her Community Tax Certificate No. APPROVED DISAPPROVED CONDITIONAL
    15841990
    ________________________issued BALINGASA MISAMIS ORIENTAL
    at _______________
    REMARKS ______________________________________________
    on _____________.
    05/24/2019 ______________________________________________________________________________
    DOCUMENTARY STAMP

    CHAIRMAN/ MEMBER ______________________ Date __________


    ____________________________________________________________
    ACTION TAKEN BY THE CASHIER
    _______________________________
    PRC ADMINISTERING OFFICER AMOUNT PAID ____________
    - OFFICIAL RECEIPT NO. _____________
    -
    PRC - CASHIER
    CASHIER _________________________________ -
    Date __________
    ____________________________________________________________
    ACTION TAKEN BY THE ISSUING OFFICER
    Administration of Oath Is Free REMARKS _______________________________________________
    (Office Order No. 2009-377 & 2009-379 ______________________________________________________________________________
    both dated September 3, 2009)
    ISSUING OFFICER ________________________ Date __________

    IMPORTANT: FAILURE TO SUBMIT THIS APPLICATION FORM WITH THE REQUIRED DOCUMENTS SHALL MEAN APP-01
    NON-INCLUSION IN THE LIST OF EXAMINEES IN THE ROOM ASSIGNMENT AND FORFEITURE OF EXAMINATION FEES Rev. 00
    February 25, 2015
    Page 1 of 1

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