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

APPLICATION NO. _______________

APPLICATION FOR CIVIL SERVICE EXAMINATION

To be filled-out by Applicant Examination Applied For : Paper-and-Pencil Test (PPT) Mode Computer-Assisted Test (CAT) Level CSE-Professional Others Last Examination Taken : (for Career Service Examination Applicants only) CSE-SubProfessional CSE-Professional Date of Exam (mm/dd/yyyy) CSE-SubProfessional Place of Examination ______________________________ Verified against: DIBAR E-Retakers OEVS For Processor ONLY CSC Regional Office ______________________________ Date of Examination (mm/dd/yyyy)

ID PHOTO (see Specifications at the back)

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. All applications must be filed PERSONALLY by applicant.
NAME (Last Name) (First Name)

CSID NO. (if any) (Middle Name) (M.I.)

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

A. FACTS OF BIRTH AGE DATE OF BIRTH (mm/dd/yyyy) SEX Male PLACE OF BIRTH Female ( Last Name) (First Name) (Middle Name) (City / Municipality) (Province) (Country)

CITIZENSHIP

MOTHERS MAIDEN NAME

B. CURRENT DEMOGRAPHIC DATA PERMANENT/MAILING ADDRESS (Room / Floor / Unit No. / Bldg. Name) (Barangay) HEIGHT (meters) WEIGHT (kg) (City / Municipality) CIVIL STATUS Single (House / Lot / Block / Phase No.) (Province) (Street Name) (Country) (Subdivision) ZIP CODE

.
MOBILE NUMBER (Required) C. EDUCATIONAL BACKGROUND

Married

Widowed

Legally Separated

Annulled

Others ______________

TELEPHONE NUMBER/S (include Area Code)

E-MAIL ADDRESS (Required)

If Not Graduated Level of Education Course/Degree Title Name of School & Address (City/Municipality & Province)
Year of Last Attendance Highest Grade/ Level/ Units Earned

If Graduated
Year Graduated Academic Honors Received

Doctorate Masters College Vocational/Technical High School Elementary D. INFORMATION ON GOVERNMENT EXAMINATIONS PASSED / CIVIL SERVICE ELIGIBILITY Title of Examination Passed / Title of Eligibility Granted Rating Obtained Date of Examination / Date Eligibility Granted Place of Examination

____________________________________________________________________ Signature over Printed Name of Applicant DO NOT FILL-OUT THE SHADED PORTION. (FOR PROCESSOR ONLY). Date: ________________ O.R. No. _____________ Amount: _____________ _____________________
Name of Collecting Officer

__________________________________________ Date Accomplished

Identification/Other Documents Presented: _______________________________________ Details: ______________________________________ ACTION TAKEN: APPROVED DISAPPROVED Reason: _________________________________ ________________________________________ Signature over Printed Name of Processor / Date

Date: ________________ O.R. No. _____________ Amount: _____________ _____________________

Name of Collecting Officer

APPLICATION RECEIPT
Examination Applied For: PPT CAT Professional TIME: ____________ SubProfessional DATE: _________________________________

APPLICATION NO. __________________________ Others _________

PLACE: ____________________________

____________________________________________
Signature over Printed Name of Processor

____________________________________
Date Received / Processed

ID PHOTO (see Specifications at the back)

To be filled-out by Applicant Applicants Name: _________________________________________________________________________________________________________

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

Sex:

Male

Female

Date of Birth (mm/dd/yyyy):

Signature: ____________________________

WARNING: The Civil Service Commission uses a highly reliable system to detect cheats. Any form of cheating in any civil service examination shall be considered a violation of Republic Act No. 9416 (Anti-Cheating Law), and any person found guilty shall be administratively and criminally liable.

~ Please continue at the Back Page ~

E. PRESENT EMPLOYMENT Government Agency/Office Private Address Non-government Organization Position/Job Title Self-Employed No. of Years in Present Position/Job Unemployed Status of Appointment/ Employment

F. OTHER INFORMATION

1. Have you ever been dismissed from the military/civil 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 decision/s. 2. Pursuant to (a) Indigenous Peoples 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 or physically challenged? YES NO

If YES, please specify: __________________________________________

G. DECLARATION

I declare under oath that I personally accomplished this application form, and I hereby certify that the information given are true, correct, and complete statements pursuant to the provisions of pertinent laws, rules, and regulations of the Republic of the Philippines. Further, I understand that the acceptance and approval of my application for the examination is based on the aforestated information. I therefore agree that, in case a post-verification yields information contrary to what is declared, my application shall be disapproved, and my payment forfeited. I further 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. In addition, I agree to undergo a validating examination in case my test results shall be found statistically improbable. Failure on my part to take the validating examination shall cause the cancellation of my test results.
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

ADM ISSION REQUI REM ENTS

____________________________ Office / Position

A P P L I C AT I O N R E Q U I R E M E N T S
Fully accomplished application form (CS Form No. 100 Revised 2012); Four (4) copies of identical pictures with specifications, as follows: taken within the last three (3) months prior to filing of application Philippine passport picture size (4.5 cm x 3.5 cm or 1.78 x 1.38) colored, with white background and printed on quality photo paper in standard close-up shot (from shoulder level up with the head and face occupying at least 80% of the picture and with the name tag positioned at approximately 1 inch below the chin) in bare face (without eyeglasses or any accessories that may cover the facial features and showing left and right ears taken in full-face view directly facing the camera, with neutral facial expression and both eyes open with full and handwritten (not computer-generated) name tag in the format: First Name, Middle Initial, Last Name, and Extension Name, if any, and signature over the printed name Original and photocopy of any valid ID containing applicants clear picture, date of birth, signature, and signature of the authorized head of the issuing agency such as Drivers License, SSS ID, GSIS ID, Philhealth ID, current Company/Office ID, current School ID, Postal ID, BIR ID, Barangay ID, Voters ID, Valid Passport, or Police Clearance (Note: Any other ID not included in the list shall NOT be accepted) For applicants without data on their date of birth in their valid ID, original and photocopy of NSO-issued Birth Certificate or Birth Certificate authenticated/issued by the Local Civil Registrar (LCR) Examination fee of Php500 for the CSE-PPT, or Php600 for the CSE-CAT. For fees of other examinations, please see related Examination Announcement.

1. 2. 3. 4.

5. 6.

1. Must be 18 years of age on the date of filing of application; 2. Must be Filipino citizen; Must be of good moral character; Must have not been convicted by final judgment of an offense or crime involving moral turpitude, or disgraceful or immoral conduct, dishonesty, examination irregularity, drunkenness or addiction to drugs; Must have not been dishonorably discharged from military service or dismissed for cause from any civilian positions in the government; and For Career Service Examination applicants, must have not taken the same level of Career Service Examination in less than three (3) months.

3.

NOTE: Applicants with pending administrative and/or criminal cases may take the examination and shall be conferred the eligibility if they successfully pass the same. However, this is without prejudice to the outcome of their pending cases. If 4. they are found guilty of grave offenses, their eligibility shall be forfeited based on the penalties stated in the decision and pursuant to Section 52 (a) of the Revised Rules on 5. Administrative Cases in the Civil Service.

REMINDERS A. FOR APPLICANTS OF CSE PAPER-AND-PENCIL TEST (CSE-PPT)

Qualified applicants shall be notified of their school assignment through an Application Receipt or a Notice of School Assignment (NOSA). They can also use the Online Notice of School Assignment (ONSA) found in the CSC Website (www.csc.gov.ph) to get a print-out of their NOSA. If applicants still do not know their school assignment or cannot get a copy of their NOSA via internet one (1) week before the examination day, they should visit or call the Regional Office or Field Office where they filed their application to inquire about their school assignment. Failure to come on your scheduled examination will mean forfeiture of examination fee and slot.

B. FOR APPLICANTS OF CSE COMPUTER-ASSISTED TEST (CSE-CAT)

Failure to come on your scheduled examination will mean forfeiture of examination fee and slot.

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. Proper attire should be worn on filing of application form and on examination day. (e.g. NOT IN SLEEVELESS SHIRT/BLOUSE, OR IN SHORT PANTS, OR IN SLIPPERS)

B R I N G T H E F O L L O W I N G O N E X AM I N AT I O N D AY
1. 2. This Application Receipt or Notice of School Assignment Same valid I.D. presented at the time of filing of application (NO I.D., NO EXAM ) 3. 4. One (1) blue or black ballpen Lead pencil/s No. 1 or 2 and eraser/s