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PRO5 RPRMD NUP Form 1, S, 2019

PROs NUP APPLICANT'S INFORMATION SHEET

This information sheet was created in compliance with para 125, Rule XII Prohibitions of 2017 Omnibus R.ules on
Appointment and Other Human Resource Actions, revised July 2018 states that: "No appointment in the national
government or any branch or instrumentallty thereof, including government-owned or controlled corparatians with
original charters shall be made in favor of a relative of the appointing or recommending officer/authority, or of the
chief of the bureau or o{fice or of the person exercising immediate supemision over the appointee . "

1) LAST NAME 2) FIRST NAME 3) MIDDLE NAME 4) QLFR.

s) poslTioN APPLYTNG FOR/PLANTILLA ITEM NO.

6) UNIT ASSIGNMENT OF PLANTILLA POSITION:

7) DO yOU HAVE ANy RELATIVE IN THE POUCE REGIONAL OFFTCE 5?

8) IF YES, PLEASE INDICATE RELATIONSHIP AND DEGREE OF KINSHIP:

9) NAME OF RELATIVE:

10) UNIT ASSJGNMENT OF THE RELATIVE:

I certify that I have personally accomplished this PR05 NUP Applicant's Information Sheet which is true, correct and
complete statement this _ day of _ at _.

Signature over printed name

In the event that any undeclared relatives would be known during the processing of appointment, subject applicant
will be automatically disqualified from the position applied for.
RPRMD, PR.O5