CS FORM No. 100 (Revised September 2016) . This Form is NOT for sale. Reproduction is allowed. APPLICATION NO.

APPLICATION NO. _______________

APPLICATION FOR CIVIL SERVICE EXAMINATION

To be filled-out by Applicant For CSC Processor ONLY
Examination Applied For : CSC Regional Office
Mode x Pen and Paper Test (PPT) ______________________________ ID PHOTO
Computerized Examination (COMEX) Date of Examination (mm/dd/yyyy)
Title x CSE-Professional CSE-SubProfessional (see Specifications at
Others Place of Examination the back)
Last Examination Taken : (for Career Service Examination Applicants only)
______________________________
CSE-Professional CSE-SubProfessional
Verified against:
Date of Exam (mm/dd/yyyy) DIBAR E-Retakers EDQIS

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) (Ext. Name, e.g. Jr./Sr., if any) (Middle Name) (M.I.)
(e.g. De La Paz = D, P, or DLP; Dela Paz = D, P, or DP)

Santos Katherine Leonor Alandy A.

AGE DATE OF BIRTH (mm/dd/yyyy) SEX PLACE OF BIRTH (City / Municipality) (Province)
0 6 1 8 1 9 8 4 Male x Female Gumaca Quezon
CITIZENSHIP MOTHER’S MAIDEN NAME ( Last Name) (First Name) (Middle Name)
Filipino Ong Ma. Carmencita Morales
COMPLETE PERMANENT MAILING ADDRESS ZIP CODE
Lot 14-A Blk 18, Lapu Lapu St., Ciudad Maharlika Subdivision, Ilayang Iyam, Lucena City, Quezon 4 3 0 1
HEIGHT (meters) WEIGHT (kg) CIVIL STATUS OTHER DATA
. . Single x Married Others ______________ Pregnant Person with Disability, please specify ________________
MOBILE NUMBER (Required) TELEPHONE NUMBER (include Area Code) E-MAIL ADDRESS (Required)
0 9 3 3 8 1 2 9 6 8 4 [email protected]

Level of Education: Elementary High School x College Master’s Doctorate

Completion: Not Graduated x Graduated If not graduated, highest Year/Level/Units earned: ____________________________________________________
06/14/2019
If graduated, date of Graduation/Completion (mm/dd/yyyy): ____________________________ Honors received: ____________________________________________

B.S. Geodetic Engineering (ETEEAP)

Complete Title of Course/Degree (for College, Master’s, Doctorate): _________________________________________________ Major: ____________________________________
MS Enverga University - Lucena City
Name and Address of School Attended: _______________________________________________________________________________ 2018-2019
Inclusive years: ____________________
(from-to)

Title of Examination Passed / Title of Eligibility Granted Rating Obtained Date of Examination / Place of Examination
Date Eligibility Granted

Government x Private Non-government Organization Self-Employed Unemployed

No. of Years in Present Status of Appointment/

Agency/Office Address Position/Job Title
Position/Job Employment

Silvino Surveying & Mapping Merchan St., Brgy. 9, Lucena City Liaison / Instrument
Man
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 an offense relative to, or in connection with, the conduct of a civil service examination?
YES NO x IF YES, attach copy/ies of decision/s.

2. Pursuant to the Indigenous People’s Act (RA 8371), are you a member of any indigenous group? YES NO x
If YES, please specify: __________________________________________

DO NOT FILL-OUT THE SHADED PORTION. (FOR CSC PROCESSOR ONLY).

Date: ________________
Identification/Other Documents Presented: _______________________________________ Details: ______________________________________
O.R. No. _____________
ACTION TAKEN: APPROVED DISAPPROVED
Amount: _____________
Reason: _________________________________ ________________________________________
_____________________ Signature over Printed Name of Processor / Date
Name of Collecting Officer

APPLICATION NO. _______________________

Date: ________________

O.R. No. _____________

Examination Applied For: PPT COMEX Professional SubProfessional Others _______
Amount: _____________
DATE: _________________________________ TIME: ____________ PLACE: ____________________________
_____________________
Name of Collecting Officer ____________________________________________
Signature over Printed Name of Processor
____________________________________
Date Received / Processed
ID PHOTO

(see Specifications at
the back)
Applicant’s Name: _________________________________________________________________________________________________________
First Name MI Last Name Ext. Name (i.e. Jr./Sr., if any)

Sex: Male Female Date of Birth (mm/dd/yyyy): Signature: ________________________

E. DECLARATION

I declare under oath that I personally accomplished this application form, and I 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 declare
that I meet and am compliant with all the admission requirements for the examination for which this application is filed.
I understand that the acceptance and approval of my application for the examination is based on the information I provided.
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 shall cause the invalidation of the result of this
examination and/or the filing of administrative/criminal case/s against me.

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 Office / Position

1. Must be Filipino citizen; 1. Fully accomplished Application Form (CS Form No. 100 Revised
2. Must be of good moral character; September 2016);
3. Must have not been convicted by final judgment of an offense or crime 2. Four (4) pieces of identical I.D. pictures with specifications, as follows:
involving moral turpitude, or disgraceful or immoral conduct, · taken within the last three (3) months prior to filing of application
dishonesty, examination irregularity, drunkenness or addiction to drugs; · Philippine passport picture size (4.5 cm x 3.5 cm or 1.78” x 1.38”)
4. Must have not been dishonorably discharged from military service or · colored, with white background and printed on good quality photo
dismissed for cause from any civilian positions in the government; and paper
5. For Career Service Examination applicants: · in standard close-up shot (from shoulder level up with the head and
a. must be at least 18 years of age on the date of filing of application. face occupying at least 80% of the picture and with the name tag
b. must have not taken the same level of Career Service Examination, positioned at approximately 1 inch or 2.54 cm. below the chin)
regardless of mode, within the last three (3) months before the date · in bare face (with no eyeglasses, colored contact lens, or any
of examination. accessories that may cover the facial features (facial features not
NOTE: a) Approval of applications may be recalled any time upon computer enhanced)
discovery of applicant’s disqualification, for which the · showing left and right ears
examination fees paid shall be forfeited. · taken in full-face view directly facing the camera, with neutral facial
b) Applicants holding dual citizenship under R.A. 9225 may expression and both eyes open
apply for and take the examination upon presentation of · with handwritten (not computer-generated) name tag legibly showing
original and photocopy of Certification of Retention/Re- signature over printed full name in the format: First Name, Middle
acquisition of Philippine Citizenship from the Bureau of Initial, Last Name, and Extension Name, if any
Immigration, and meeting of all the other admission and 3. Original and photocopy of any of the following I.D. cards, which must be
application requirements for the examination. valid (not expired upon filing of application), and contains the name,
c) Applicants with pending administrative and/or criminal cases clear picture, date of birth and signature of applicant, and the name and
may take the examination and shall be conferred the signature of the issuing agency’s current head/authorized representative:
eligibility if they successfully pass the same. However, this Driver’s License, Passport, PRC ID, SSS ID, GSIS ID/ GSIS UMID ID,
is without prejudice to the outcome of their pending cases. Philhealth ID (must at least contain the applicant’s name, clear picture,
If they are found guilty, their eligibility shall be forfeited signature and Philhealth number), current Company/Office ID, current
based on the penalties stated in the decision and under School ID (validated for the current school year/semester/trimester),
existing Civil Service Law and Rules. Postal ID, BIR ID (ATM type/TIN card type with picture), Barangay ID,
d) Passers of the regular Bar examination given by the Voter’s ID, Police Clearance/Police Clearance Certificate, or NBI
Supreme Court of the Philippines and of Board Clearance (Note: All other ID cards NOT included in the list shall
examinations given by the PRC are automatically granted a NOT be accepted).
civil service eligibility. They are automatically considered as 4. For applicants without date of birth in their I.D. card/s, original and
civil service eligibles pursuant to CSC Resolution No. photocopy of Birth Certificate issued by the Philippine Statistics Authority
90-1212. Thus, they may opt not to apply and take the (formerly National Statistics Office) or the Local Civil Registry printed on
corresponding examination anymore. Also, individuals who Security Paper (SecPa).
were granted the Honor Graduate Eligibility (HGE) pursuant 5. For applicants holding dual citizenship under R.A. 9225, original and
to P.D. 907 may opt not to apply and take the corresponding photocopy of Certification of Retention/Re-acquisition of Philippine
examination anymore. Citizenship issued by the Bureau of Immigration.
6. Examination fee of PhP500 for the CSE-PPT, or PhP680 for the CSC
For specific admission requirements of other examinations, please see
COMEX. For fees and additional application requirements of other
related Examination Announcement.
examinations, please see related Examination Announcement.

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.

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

Qualified applicants shall be notified of their school assignment through an Application Receipt or a Notice of School Assignment (NOSA) via SMS or e-mail. They can also use as
applicable the Online Notice of School Assignment (ONSA) found in the CSC Website (www.csc.gov.ph) to verify and get a print-out of their NOSA, or access related Exam
Advisory posted in the CSC website. 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. Applicants are also advised to conduct
ocular inspection of their school assignment one (1) day before examination day. Failure to come on scheduled examination will mean forfeiture of examination fee and slot.
Rescheduling of examination date is NOT allowed.
B. FOR APPLICANTS OF CSC COMPUTERIZED EXAMINATION (CSC COMEX)
Failure to come on scheduled examination will mean forfeiture of examination fee and slot. Rescheduling of examination date is NOT allowed.

IMPORTANT: All personal belongings including articles in clothing (hats/caps, shades, and the like), digital watches/watch calculators, calculators, cellular phones,
books, ipads/tablets, and all other electronic gadgets and printed materials shall 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).
MAIN GATES OF TESTING VENUES SHALL BE CLOSED AT 7:30 A.M. ON EXAMINATION DAY.

1. This Application Receipt and/or Notice of School Assignment 3. Black ballpen/s

2. Same valid I.D. presented at the time of filing of application (NO I.D., NO EXAM)