Name: ______________________________________________________________________

Position Applied To: __________________________________________________________

WORK EXPERIENCE SHEET

Attachment to CS Form No. 212 (Personal Data Sheet), per CSC MC No. 11, s. 2017

Instructions: 1. Include only the work experiences relevant to the position being applied
to.
2. The duration should include start and finish dates, if known, month in
abbreviated form, if known, and year in full. For the current position, use the
word Present, e.g., 1998-Present. Work experience should be listed from
the most recent first.
Position Title
Name of Office/Unit/Division
Duration
Name of Agency/Organization
and Location
Immediate Supervisor

 List of Accomplishments and Contributions (if any):

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

 Summary of Actual Duties and Responsibilities:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

(Continue on separate sheet, if necessary)

____________________________
Signature over Printed Name of
Employee/Applicant
 Date: _____________________

WORK EXPERIENCE SHEET

Attachment to CS Form No. 212 (Personal Data Sheet), per CSC MC No. 11, s. 2017

Position Title
Name of Office/Unit/Division
Duration
Name of Agency/Organization
and Location
Immediate Supervisor

 List of Accomplishments and Contributions (if any):

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

 Summary of Actual Duties and Responsibilities:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

(Continue on separate sheet, if necessary)

____________________________
Signature over Printed Name of
Employee/Applicant

Date: _____________________

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