The document is an application form for the Registered Electrical Engineer examination scheduled for April 24-25, 2024, with an appointment date of February 14, 2024. The applicant, Carlo Canda Garcia, is a first-time examinee from Pampanga, Philippines, and has paid the application fee of PHP 900.00, confirming that all provided information is true and correct under penalty of law.
The document is an application form for the Registered Electrical Engineer examination scheduled for April 24-25, 2024, with an appointment date of February 14, 2024. The applicant, Carlo Canda Garcia, is a first-time examinee from Pampanga, Philippines, and has paid the application fee of PHP 900.00, confirming that all provided information is true and correct under penalty of law.
The document is an application form for the Registered Electrical Engineer examination scheduled for April 24-25, 2024, with an appointment date of February 14, 2024. The applicant, Carlo Canda Garcia, is a first-time examinee from Pampanga, Philippines, and has paid the application fee of PHP 900.00, confirming that all provided information is true and correct under penalty of law.
The document is an application form for the Registered Electrical Engineer examination scheduled for April 24-25, 2024, with an appointment date of February 14, 2024. The applicant, Carlo Canda Garcia, is a first-time examinee from Pampanga, Philippines, and has paid the application fee of PHP 900.00, confirming that all provided information is true and correct under penalty of law.
APPOINTMENT DATE: Feb 14, 2024 (08:00 AM TO 09:00 AM) - Robinsons Starmills
Professional Regulation Commission
APPLICATION FORM
NOT FOR SALE (REPRODUCTION IS ALLOWED)
REFERENCE NO: EXJ0174T40VZ Application No. OR: E2024-02-07540949 | AMOUNT: PHP 900.00 030676 X First Timer Repeater Name of Examination REGISTERED ELECTRICAL ENGINEER _________________________________ Conditioned Date of Examination APRIL 24 - 25, 2024 _________________________________ Absent Place of Examination Pampanga (Region III) _________________________________ ________________ 02/13/2024 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 GARCIA CARLO CANDA Maiden Surname (for married female only)
Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City) N/A 7TH STREET SANROS SUBDIVISION ANAO MEXICO, PAMPANGA Gender Citizenship Contact numbers (Landline & Mobile) E-mail Address X Male Female X Filipino Others______ 09363585984 [email protected] Civil Status Date of Birth(mm/dd/yy) Place of Birth (City/Town,Prov) RURBAN Code(Town/City,Prov) X Single Married Widow/er 09/30/2000 ANGELES CITY, PAMPANGA 035401 Spouse’s name & Citizenship Father’s Name & Citizenship Mother’s Name & Citizenship PETER LESLEY GARCIA / FILIPINO ANNA LIZA GARCIA / 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 DON HONORIO VENTURA TECHNOLOGICAL STATE UNIVERSITY BACOLOR, PAMPANGA 0049 Degree/Course Obtained PRC COURSE Code Date Graduated (mm/dd/yy) PRC Board Code BS IN ELECTRICAL ENGINEERING 3047 2023 1100 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.
STATUS CODES (refer at the back) 1.) Examination Type (EXcode) 2.) Number of Times Taken 0
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 N/A ________________________issued N/A at _______________ REMARKS ______________________________________________ on _____________. 02/08/2024 ______________________________________________________________________________ DOCUMENTARY STAMP
CHAIRMAN/ MEMBER ______________________ Date __________
____________________________________________________________ ACTION TAKEN BY THE CASHIER _______________________________ PRC ADMINISTERING OFFICER AMOUNT PAID ____________ 900.00 OFFICIAL RECEIPT NO.E2024-02-07540949 _____________ Paymaya - Gcash Payment CASHIER _________________________________ 02/13/2024 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
