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CAREER SERVICE RA 10 BOARD BA) UNDER
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if of brea or feo te person Who has immedi supension over you the
‘ureauor Deparment whee yu wl be arcocited,
‘2. witin teted degree? Ores
bwin tft degree (fr Local Goverment Unit = Career Employes)? Ovs Ono
YES, ge deta:
‘5 & Fave you ever Doe oad gun of any earnsvave ese? De em
YES, go deta:
'b. Have youbean eriminaly charged before any cout? ows
YES, ge deta:
Date Fe:
Status of Casals
3s Have you eer been concede any Seo volo yaw, aces, onan et | ves ae
regulation by any court tuna? TYEE, pede
[3 Have you ever bon separated fom he senha any oT lowing modes: eagnaon, | ves No
retrenent roped tom ers dsnssa eminaon, end offer, fished conract ce | TIYES. che deta:
phased out (solo) inthe public pve secto?
[Hr a Have you eve been a candidate a natal orc Secon fed win We al you
Ovs BN
(except Barangay elector)? YES, gh deta:
Have you resigned fo he goverment sevice during the tee (3}month pend bere | ves Gn
the last election n promatnacvelycapain fr anaonal orca canal? YES, gh deta:
28, Have you aired estas oan mga or pemanent eet ecterauney? | cy ves 3
YES, give dts (court:
Fo Parana) nips Peoples hal (RA B71} Mapa Cara or Died Porson
(RATZTT; and () Soo Parents Wetre Aco 2000 (RA 8372), please answer te floning
+ Areyoua member any incigenous group? oes aN
Irs; pease spect.
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re yeu person wih dsabiny? Oves
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11 REFERENCES Peay etsy nara aol pe Fo)
Te oy TEN
‘VICE MAYOR AMADO NOBLE,JR ‘TALAKAG BUKINON NA
‘SHERWIN LANDAR (SANGUNIANG BAYAN SECRETARY) | TALAKAGBUKONON | 9172474507
‘ataxaceunenon | s67sezr4s2
"= Tdecare under ca at Pave prsnalyeccorplshed Wis Persaral Daa Shel Whch awe, Come and
‘complete statement punt ote rovsons of pertinent ans, des end regulations ofthe Repub of he
Phipps. | suorze the agency headauhorzed representa to veriylakile the contents stated
| agree that any misrepresentaon mad inthis document and is tachment shal causa he
aleeoreen
ear aesance: WHT CKOAYANDEOROGIY
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