Cs Form 212 Revised – Fill Out and Use This PDF

CS FORM No. 100 (Revised November 2012) . This Form is NOT for sale. Reproduction is allowed.

APPLICATION NO. _______________

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”.

CSID NO. (if any)

All applications must be filed PERSONALLY by applicant.

NAME

(Last Name)

(First Name)

(Ext. Name, i.e. Jr./Sr., if any)

(Middle Name)

(M.I.)

A. FACTS OF BIRTH

AGE

DATE OF BIRTH (mm/dd/yyyy)

SEX

PLACE OF BIRTH

(City / Municipality)

(Province)

(Country)

Male

Female

PERMANENT/MAILING ADDRESS (Room / Floor / Unit No. / Bldg. Name)

(House / Lot / Block / Phase No.)

(Street Name)

(Subdivision)

(Barangay)

(City / Municipality)

(Province)

(Country)

ZIP CODE

HEIGHT (meters) WEIGHT (kg)

CIVIL STATUS

.

Single

Married

Widowed

Legally Separated

Annulled

Others ______________

MOBILE NUMBER (Required)

TELEPHONE NUMBER/S (include Area Code)

E-MAIL ADDRESS (Required)

C. EDUCATIONAL BACKGROUND

If Not Graduated

If Graduated

Level of Education

Course/Degree Title

Name of School & Address (City/Municipality & Province)

Year of Last

Highest Grade/

Year

Academic Honors

Level/ Units

Attendance

Graduated

Received

Earned

Doctorate

Master’s

College

Vocational/Technical

High School

Elementary

____________________________________________________________________

__________________________________________

Signature over Printed Name of Applicant

Date Accomplished

DO NOT FILL-OUT THE SHADED PORTION. (FOR PROCESSOR ONLY).

Date: ________________

Identification/Other Documents Presented: _______________________________________ Details: ______________________________________

O.R. No. _____________

ACTION TAKEN: APPROVED

DISAPPROVED

Amount: _____________

_____________________

Reason: _________________________________

________________________________________

Signature over Printed Name of Processor / Date

Name of Collecting Officer

APPLICATION RECEIPT

APPLICATION NO. __________________________

Date: ________________

O.R. No. _____________

Examination Applied For:

PPT

CAT

Professional

SubProfessional

Others _________

Amount: _____________

DATE: _________________________________

TIME: ____________

PLACE: ____________________________

_____________________

____________________________________________

____________________________________

Name of Collecting Officer

ID PHOTO

Signature over Printed Name of Processor

Date Received / Processed

To be filled-out by Applicant

(see Specifications at

Applicant’s Name: _________________________________________________________________________________________________________

the back)

First Name

MI

Last Name

Ext. Name (i.e. Jr./Sr., if any)

Government

Private

Non-government Organization

Self-Employed

Unemployed

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.

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: __________________________________________

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

APPLICATION REQUIREMENTS

1.

Must be 18 years of age on the date of filing of application;

1.

Fully accomplished application form (CS Form No. 100 Revised 2012);

2.

Must be Filipino citizen;

2.

Four (4) copies of identical pictures with specifications, as follows:

•

taken within the last three (3) months prior to filing of application

3.

Must be of good moral character;

•

Philippine passport picture size (4.5 cm x 3.5 cm or 1.78” x 1.38”)

4.

Must have not been convicted by final judgment of an offense or

•

colored, with white background and printed on quality photo paper

crime involving moral turpitude, or disgraceful or immoral conduct,

•

in standard close-up shot (from shoulder level up with the head and face

dishonesty, examination irregularity, drunkenness or addiction to

occupying at least 80% of the picture and with the name tag positioned at

drugs;

•

approximately 1 inch below the chin)

5.

Must have not been dishonorably discharged from military service or

in bare face (without eyeglasses or any accessories that may cover the facial

features and showing left and right ears

dismissed for cause from any civilian positions in the government;

•

taken in full-face view directly facing the camera, with neutral facial expression

and

and both eyes open

6. For Career Service Examination applicants, must have not taken the

•

with full and handwritten (not computer-generated) name tag in the format: First

same level of Career Service Examination in less than three (3)

Name, Middle Initial, Last Name, and Extension Name, if any, and signature over

months.

the printed name

3. Original and photocopy of any valid ID containing applicant’s clear picture, date of

NOTE: Applicants with pending administrative and/or criminal cases

birth, signature, and signature of the authorized head of the issuing agency such as

may take the examination and

shall be conferred

the

Driver’s License, SSS ID, GSIS ID, Philhealth ID, current Company/Office ID, current

School ID, Postal ID, BIR ID, Barangay ID,

Voter’s ID, Valid Passport, or Police

eligibility if they successfully pass the same. However, this is

Clearance (Note: Any other ID not included in the list shall NOT be accepted)

without prejudice to the outcome of their pending cases.

If

4.

For applicants without data on their date of birth in their valid ID, original and

they are found guilty of grave offenses, their eligibility shall be

photocopy of NSO-issued Birth Certificate or Birth Certificate authenticated/issued by

forfeited based on the penalties stated in the decision and

the Local Civil Registrar (LCR)

pursuant to Section 52

(a) of

the Revised Rules

on

5.

Examination fee of Php500 for the CSE-PPT, or Php600 for the CSE-CAT. For fees of

Administrative Cases in the Civil Service.

other examinations, please see related Examination Announcement.

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.

1.

This Application Receipt or Notice of School Assignment

3.

One (1) blue or black ballpen

2.

Same valid I.D. presented at the time of filing of application (NO I.D., NO EXAM )

4.

Lead pencil/s No. 1 or 2 and eraser/s