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

07

yyyy )

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) (MIDDLE NAME) (M.I.) (LAST NAME)

3. APPLICANT'S MAIDEN NAME: _________________________ __________________________ ____________________

(FIRST NAME)

4. COMPLETE MAILING ADDRESS Zip Code Tel. No.: _______________ ____________________________________________________________________________________No.: ______________ Cell. 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 Of Attendance TO FROM Academic Honors Received

13. PRESENT EMPLOYMENT

AGENCY/OFFICE/ADDRESS

Government

Private
LENGTH OF EXPERIENCE IN PRESENT POSITION

POSITION LEVEL/ SALARY GRADE RANK(for PNP/AFP)

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 YES [ ] NO [ ] If YES , attach copy/ies of decisions. examination? 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.
Printed Name and Signature of Collecting Officer

Date: ____________________________ O.R. No. ________________________ Amount: __________________________ ____________________________________

_______________________
Signature of Applicant
Right Thumbmark

Subscribed and sworn to before me this ________ day of __________________ 2007.

Recently taken Passport Size Photo w/ Name Tag (Full Name) [1 1/2" x 2"] (taken within 3 mos) Scanned/DigitallyImaged/Photocopied picture not accepted

ADMINISTERING OFFICER
(Signature above Printed Name)

OFFICE/POSITION

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

Printed Name and Signature of Collecting Officer

Date: ____________________________ O.R. No. ________________________ Amount: __________________________ ______________________________________

APPLICATION RECEIPT Application No. ____________ Received the application for the: CAREER EXECUTIVE OFFICER EXAMINATION TIME: ___________________ Printed Name of Processor: _________________________ 7:00 am DATE: _____________________ Signature of Processor: _____________________ JUNE 10, 2007 PLACE: ___________________________ Date Received/Processed: ________________ Applicant's Printed Name: _____________________________________________________ Birthdate: _____________________________________ Sex: _________________________ Signature: _______________________________________________________________________

Recently taken Passport Size Photo w/ Name Tag (Full Name) [1 1/2" x 2"] (taken within 3 mos) Scanned/DigitallyImaged/Photocopied picture not accepted

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.

- Please see Back see Back Other for Other Important Examination Information - Please Page for Page 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
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.

BRING THE FOLLOWING ON EXAMINATION DAY 1. This Application Receipt 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

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

SCHEDULED EXAMINATION WILL MEAN FORFEITURE OF EXAMINATION

by the Security Officers. The Commission will not be liable for the loss or damage of said belongings.

ON NO. ________

25, 2006 CEOE

____________

_____________

(LAST NAME)

______________ _____________ ______________

: ____________

Academic Honors Received

of Examination

ous, disgraceful of a civil service

the best of my aws, rules and

of examination

ently taken rt Size Photo ame Tag ll Name) 1/2" x 2"] within 3 mos) ned/Digitally-

/Photocopied not accepted

________________

ature of Processor

ently taken rt Size Photo ame Tag ll Name) 1/2" x 2"] within 3 mos)

ned/Digitally/Photocopied not accepted

ad to

on -

__________ ___________ ____________

understand that

rification of the

amination and/or

supervisory/ monitoring & based on the _ years now.

_______ FFICIAL

ease answer

NATION DAY

e, birthdate ( if

head of agency

nse/BIR/SSS)

e ID card

materials outside

will be confiscated

on will not be liable