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CSC 08

This document contains an application form for the Local Scholarship Program - Bachelor's Degree Completion (LSP-BDC) in the Republic of the Philippines. The 21-item application requests information such as the applicant's personal details, education history, employment record, performance ratings, pending cases, and nomination from their agency head. It instructs applicants to fill out all required information and submit documents to the appropriate CSC Regional Office. It also provides instructions for applicants on what to bring on the examination day.

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chanel143
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127 views1 page

CSC 08

This document contains an application form for the Local Scholarship Program - Bachelor's Degree Completion (LSP-BDC) in the Republic of the Philippines. The 21-item application requests information such as the applicant's personal details, education history, employment record, performance ratings, pending cases, and nomination from their agency head. It instructs applicants to fill out all required information and submit documents to the appropriate CSC Regional Office. It also provides instructions for applicants on what to bring on the examination day.

Uploaded by

chanel143
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

CS FORM 101-B CIVIL SERVICE COMMISSION Recently taken


Revised December 2002 Passport Size Photo
THIS FORM IS NOT FOR SALE (1½ x 2 inches)
REPRODUCTION IS ALLOWED with Name Tag

Computer or machine
APPLICATION FOR COMPETITIVE EXAMINATION Generated picture is
LOCAL

SCHOLARSHIP
  
 PROGRAM
  !" # NOT accepted

INSTRUCTIONS TO APPLICANTS:
Please fill in all the required information in this Application and submit the documents to be required by the CSC Regional Office.

1. APPLICANT’S PRINTED NAME __________________________________________________________________________________________________________


Surname Given Name Middle Name Maiden Name
2. COMPLETE MAILING ADDRESS ____________________________________________________________ZIP CODE_______ 3. TEL. NO. ________________
4. DATE OF BIRTH ___________________ 5. PLACE OF BIRTH _____________________ 6. AGE: ______ 7. SEX _______ 8. CIVIL STATUS ________
9. AGENCY NAME & ADDRESS _____________________________________________10. OFFICE TEL. NO. _____________ 11. CITIZENSHIP ____________

12. EDUCATION: DO NOT FILL THIS


_______________________ _________________________ __________________ ____________________ PORTION
Bachelor’s Course School Inclusive Dates Highest Year in College (FOR CODERS ONLY)
Completed
13. HAVE YOU FINISHED ANY BACHELOR’S DEGREE COURSE? _____ YES ______ NO; If YES , pls state: S
__________________________________________________________________________________
YG
14. ARE YOU SERVING A SCHOLARSHIP CONTRACT? _____ YES _____ NO ; If YES , pls state:___________________
__________________________________________________________________________________
DF
15. ARE YOU IN GOOD HEALTH? ___ YES ___ NO (Attach Medical Certificate)
MFS
16. RECORD OF EMPLOYMENT IN THE GOVERNMENT (Please attach another sheet, if necessary)
INCLUSIVE DATES POSITION SALARY PER STATUS OF COMPLETE NAME &
FROM TO MONTH APPOINTMENT ADDRESS OF OFFICE

17. PERFORMANCE RATING (For the last two rating periods) 1ST RATING PERIOD ____________________ 2ND RATING PERIOD _____________________

18. DO YOU HAVE ANY PENDING ADMINISTRATIVE CASE? ___ YES ___ NO; CRIMINAL CASE? ___ YES ___ NO; If YES, give details of the offense
________________________________________________________________________________________________________________________________________

19. HAVE YOU EVER BEEN CONVICTED OF ANY ADMINISTRATIVE OFFENSE? ___ YES ___ NO; If YES, give details of the offense
________________________________________________________________________________________________________________________________________

20. I declare under the penalties of perjury that this application has been accomplished 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.

_____________________________________________
Signature of Applicant/Date

21. NOMINATION:

I nominate Mr./Ms. _______________________________ to the Local Scholarship Program - Bachelor's Degree Completion. Once qualified, I will allow the
scholar to study on official time for one year. I will relieve the scholar from all duties and responsibilities during this period.

_____________________________________________
Signature over Printed Name of Head of Agency
Subscribed and sworn to before me this _________ day of ______________________________, ________.

_________________________________________ ____________________________
Signature over Printed Name of Administering Officer Office/Position

$ FOR PROCESSORS/EVALUATORS ONLY: ACTION TAKEN Approved Disapproved (Signature of First Processor/Date)

APPLICATION R E C E I PT Application No. __________

RECEIVED THE APPLICATION FOR THE LOCAL SCHOLARSHIP PROGRAM - BACHELOR'S


DEGREE COMPLETION (LSP-BDC) Recently taken
DATE : _________________________ PLACE :_________________________ TIME : ____________________
Passport Size Photo
SIGNATURE OF PROCESSOR: _____________________ DATE PROCESSED:_________________ (1½ x 2 inches)
with Name Tag
APPLICANT’S PRINTED NAME: _________________________________________________________ SEX _________

BIRTHDATE:__________________ PLACE OF BIRTH_________________________SIGNATURE______________________ Computer or machine


Generated picture is
Bring the following on examination day:
1. Application Receipt/Notice of Assignment 4. Lead (black)pencils & eraser NOT accepted
2. Two pcs. 1½ x 2 inches recent ID photo w/ name tag
3. One blue or black ballpen 5. Identification Card (ID)
.
WARNING: IMPERSONATION OR CHEATING EQUALS DISMISSAL AND/OR IMPRISONMENT

OREP-ESD2/jv

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