Republic of the Philippines

Department of Finance
BUREAU OF INTERNAL REVENUE
Quezon City

Date

Name of Applicant:
Applied Position:
Preferred Place of Assignment: 1.)
2.)
3.)
I have been well informed and briefed regarding the job vacancies in the Bureau and the position I have written
on this form is what I am applying for.

Relative(s) in the BIR With Relative/s Without Relative/s

If with relative, please write the name and check the appropriate box & encircle the relationship with the
applicant

1 ________________________ Father/Mother Uncle/Aunt (brother/sister of mother/father or brother-in-

2 ________________________ Brother/Sister law/sister-in-law of mother/father)
3 ________________________ Husband/Wife First Cousin
4 ________________________
Son/ Daughter In-law (Father/Mother/Brother/Sister)
I declare under the penalties of perjury that the above answers are made in good faith and to the best of
my knowledge and belief are true and correct. That if it is later found that I have a relative in the BIR under the
following circumstances (Sec.6 of Rule XVIII of Omnibus Rules Implementing Book V of Executive Order No. 292 and
Other Pertinent Civil Service Laws):

1. Head of Agency
2. Appointing Authority
3. Recommending Official
4. Immediate Supervisor/Superior

I am willing to have my appointment revoked because my employment is a violation of existing Civil Service Law and
Rules.

Signature of Applicant
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WAIVER ON PLACE OF WORK ASSIGNMENT
In the event that I am selected by the Board and I have accepted the job offered by the Bureau of Internal
Revenue, I hereby agree to be assigned to any BIR office to meet the urgent needs of the Bureau.

I shall comply with all the rules and regulations, and policies issued by the Bureau, as well as with all
orders and instructions of my duly designated superiors and other authorized officers.

Name and Signature of Applicant

Date: