CS FORM No.

100-C (Revised 2007) THIS FORM IS NOT FOR SALE REPRODUCTION IS ALLOWED

Republic of the Philippines CIVIL SERVICE COMMISSION Region: _________________

APPLICATION NO. ________

NOTE: THOSE WHO HAVE ALREADY TAKEN AND FAILED BOTH THE JULY 17, 2005 CSEE/MATB AND THE JUNE 25, 2006 CEOE WILL ONLY BE QUALIFIED TO TAKE THE CEOE IN 2009.

CAREER EXECUTIVE OFFICER EXAMINATION (CEOE) TITLE OF EXAMINATION APPLIED FOR

[READ THE EXAMINATION ANNOUNCEMENT. DO NOT APPLY IF YOU ARE NOT QUALIFIED]

DATE OF EXAM:
( mm / dd /

06 10
yyyy )

0 7

PLACE OF EXAM:

1. APPLICANT'S NAME (PRINT IN CAPITAL LETTERS) __________________ __________________________ _____ ______________________ _______ 2. AGE: ____________
(LAST NAME) (For Married Women) (FIRST NAME) Name Extension,e.g. Jr., Sr., III) (MIDDLE NAME) (FIRST NAME) (MIDDLE NAME) (M.I.) (LAST NAME)

3. APPLICANT'S MAIDEN NAME: _________________________ __________________________ _________________ 4. COMPLETE MAILING ADDRESS Zip Code Tel. No.: _______________ ____________________________________________________________________________________ Cell. No.: ______________ 5. CIVIL STATUS: _______________ 6. SEX:Male Female 7.HEIGHT(m.) _____8.WEIGHT(kg)_____ Email add:_______________ 9. BIRTHDATE:
( yyyy mm dd)

10. BIRTHPLACE : ______________________ 11. CITIZENSHIP: ____________

(City / Town / Province)

12. HIGHEST EDUCATIONAL ATTAINMENT:

Level of Education Course/Degree (Write in full) Highest Grade/Year/ Level/Units Earned (Or Write Graduated) Name of School Attended and School Address Inclusive Years Academic Of Attendance Honors Received FROM TO

13. PRESENT EMPLOYMENT o Government o Private

AGENCY/OFFICE/ADDRESS POSITION LEVEL/ SALARY GRADE RANK(for PNP/AFP) POSITION LENGTH OF EXPERIENCE IN PRESENT POSITION STATUS OF APPOINTMENT/ EMPLOYMENT

14. CIVIL SERVICE/BOARD/BAR/EXAMINATIONS PASSED (Use separate sheet if necessary)

Rating Date of Exam Place of Examination

15. Have you ever been dismissed from the service for cause, or found guilty of crime involving moral turpitude, or of infamous, 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 decisions. 16. Have you passed the same examination? YES [ ] NO [ ]

I declare under oath that this application has been accomplished by me 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 pertinent laws, rules and regulations of the Republic of the Philippines. I likewise agree that I will subject myself to a validating examination in case the test results in my place of examination are statistically improbable.
Date: ____________________________ O.R. No. ________________________ Amount: __________________________ ____________________________________ Printed Name and Signature of Collecting Officer

Recently taken _______________________ Passport Size Photo w/ Name Tag Signature of Applicant (Full Name) [1 1/2" x 2"] Right Thumbmark (taken within 3 mos) Subscribed and sworn to before me this ________ day of __________________ 2007. Scanned/DigitallyADMINISTERING OFFICER
(Signature above Printed Name)

OFFICE/POSITION

Imaged/Photocopied picture not accepted

( Do not fill-up this portion. For Processor/s only) ACTION TAKEN: APPROVED [ ] DISAPPROVED [ ] DATE _____________ _________________________________ Printed Name and Signature of Processor

Date: ____________________________ O.R. No. ________________________ Amount: __________________________ ______________________________________ Printed Name and Signature of Collecting Officer

A P P L I C A T I O N R E C E I P T Application No. ____________ Recently taken Received the application for the: CAREER EXECUTIVE OFFICER EXAMINATION Passport Size Photo w/ Name Tag TIME: ___________________ Printed Name of Processor: _________________________ (Full Name) DATE: _____________________ Signature of Processor: _____________________ [1 1/2" x 2"] PLACE: ___________________________ Date Received/Processed: ________________ within 3 mos) (taken Applicant's Printed Name: _____________________________________________________ Birthdate: _____________________________________ ex: _________________________ S Signature: _______________________________________________________________________ Scanned/DigitallyImaged/Photocopied picture not accepted

Date: ___________ No. ____________ ________________ ________________ Printed Name and Officer

WARNING: Impersonation, cheating and other forms of examination irregularity would lead to dismissal from government service, perpetual disqualification from taking civil service examinations and from entering government service and/or imprisonment.

- PleasePlease seePage for Other Important Examination Information - see Back Back Page for Other Important Examination Information -

DECLARATION:
1. How many subordinates/staff do you supervise? none 1 2 3 4 5 more than 5

2. Reasons for taking the CEOE: _______________________________________________________________________ 3. Have you attended review classes in preparation for the examination? _________________________________________ If YES, what Review Center? __________________________________________________________________________

I declare that the abovementioned information are true and correct to the best of my knowledge and belief. I understand that the acceptance of my application for the examination is based on the abovecited declaration.

I therefore agree that in case my application is approved based on the declarations made and should a post verification of the information supplied yield information contrary to what is declared, my application shall be disapproved and my payment forfeited.

In addition, I agree that any misrepresentation made in this document may cause the invalidation of the result of this examination and/or the filing of administrative/criminal case/s against me. Done this __________ day of _______________________, 2007. APPLICANT (Signature over Printed Name)

TO BE FILLED-UP BY THE HEAD OF THE AGENCY/AUTHORIZED OFFICIAL Note : For those occupying SG 18 - 21, if in government, and those in the private sectors only

This is to certify that Mr./Ms. ____________________________ of this Agency/Office has been performing supervisory/ managerial functions (i.e. directing & approving work outputs of employees; delegating functions to the staff; monitoring & rating employees' performance based on duly approved performance targets; & supervising the unit/division based on the staffing pattern/organizational structure), and supervising/managing _____________ staff for ____________ years now.
(number of staff) (number of years)

_____________________________________________ NAME and ADDRESS OF AGENCY/OFFICE

_____________________________________ HEAD OF AGENCY/AUTHORIZED OFFICIAL (Signature over Printed Name)

OTHER INFORMATION:
1. Pursuant to (a) Indigenous People's Act (RA 8371); and (b) Magna Carta for Disabled Persons (RA 7277), please answer the following items: a) Are you a member of any indigenous group? YES [ ] NO [ ] If YES, please specify: b) Are you differently abled? YES [ ] NO [ ] If YES, please specify: 2. Are you willing to work in the Government? YES [ ] NO [ ] 3. If YES, list three (3) preferred Government Agencies: Area or Region a) b) c) 4. Preferred Position:

Preferred Salary:

IMPORTANT

BRING THE FOLLOWING ON EXAMINATION DAY

1. This Application Receipt IF YOU FAIL TO RECEIVE YOUR NOTICE OF ASSIGNMENT ONE [1] WEEK BEFORE THE EXAMINATION, PLEASE VISIT OR CALL THE REGIONAL OFFICE WHERE YOU FILED YOUR APPLICATION TO INQUIRE ABOUT YOUR SCHOOL ASSIGNMENT. FOR NCR APPLICANTS, PLEASE VISIT OUR WEBSITE: FEE AND SLOT. 2. One [1] blue or black ballpen 3. Lead pencil/s no. 2 and eraser/s 4. Valid I.D. Card with photo, signature, birthdate ( if available), and signature of authorized head of agency (Office/School/Postal ID/Passport/License/BIR/SSS) * This should be the same with the ID card presented at the time of application. * NO I.D., NO EXAM. * DO NOT bring cellular phones & other materials outside of those above-listed, otherwise, they will be confiscated by the Security Officers. The Commission will not be liable for the loss or damage of said belongings.

www.csc.gov.ph. FAILURE TO COME ON YOUR

SCHEDULED EXAMINATION WILL MEAN FORFEITURE OF EXAMINATION

CATION NO. ________

B AND THE JUNE 25,

_____ 2. AGE: ____________

_______ ____________________
(LAST NAME)

o.: _______________ o.: ______________ dd:_______________

ZENSHIP: ____________
Academic Honors Received

STATUS OF APPOINTMENT/ EMPLOYMENT

Place of Examination

pitude, or of infamous, disgraceful with the conduct of a civil service

fied by me and to the best of my s of pertinent laws, rules and

lts in my place of examination

Recently taken assport Size Photo w/ Name Tag (Full Name)

aken within 3 mos) Scanned/Digitally-

aged/Photocopied cture not accepted

_________________________

nd Signature of Processor

Recently taken assport Size Photo w/ Name Tag (Full Name)

aken within 3 mos)

Scanned/Digitallyaged/Photocopied cture not accepted

_______________________ ________________________ _______________________

dge and belief. I understand that

should a post verification of the nd my payment forfeited.

he result of this examination and/or

s been performing supervisory/ ns to the staff; monitoring & g the unit/division based on the ___________ years now.

_____________

ns (RA 7277), please answer

N EXAMINATION DAY

signature, birthdate ( if

uthorized head of agency

port/License/BIR/SSS)

me with the ID card

& other materials outside they will be confiscated

Commission will not be liable