CS Form No.

1
Revised 2017
For Use of Regulated
APPOINTMENT TRANSMITTAL AND ACTION FORM

AGENCY:
AGENCY : Local Government Unit - Opol CSCFO In-Charge:

INSTRUCTIONS: For CSCRO/FO's Use:

(1) Fill-out the data needed in the form completely and accurately. Date Received:
(2) Do not abbreviate entries in the form. SALARY/
(3) Accomplish the Checklist of Common Requirements and sign the certification. JOB/
(4) Submit the duly accomplished form in electronic and printed copy (2 copies) to the CSC Field Office-In-Charge
together with the original copies of appointments and supporting documents. A = Approved

POSITION TITLE
NAME OF THE APPOINTEE/S PUBLICATION CSC AC

PERIOD OF EMPLOYMENT or
DATE OF DATE
Name EMPLOYMENT NATURE OF
(for Temporary, Casual/ ISSUANCE indicate period of MODE
Last Name First Name Extension Middle Name STATUS APPOINTMENT publication (CSC Bulletin of
Contractual Appointments) (mm/dd/yyyy)
(Jr. / III) (mm/dd/yyyy to mm/dd/yyyy) (mm/dd/yyyy to Vacant Positions)
mm/dd/yyyy)
(indicate
No. parenthetical title, if
applicable) SG-15, 11/09/ 2018 to CSC Bulletin
1 Cainhog Roland Bangoy Market Specialist II Step 1 Permanent Promotion 1/3/2019 11/ 26/ 2018 RO-10
D=
Disapproved
Administrative Officer PAY
IV (Management and SG-15,
GRADE 11/ 23/2018 to CSC Bulletin
2 Loreno Jonathan Losbañes Audit Analyst II) Step 1 Permanent Promotion 1/3/2019 12/10/2018 RO-10
SG-11, 11/09/ 2018 to CSC Bulletin
3 Arancon Rodelia Tuquib Librarian I Step 1 Permanent Original 1/3/2019 11/ 26/ 2018 RO-10
Carpenter General SG- 11/09/ 2018 to CSC Bulletin
4 Pakino Jefrey Vacalares Foreman 10,Step 1 Permanent Original 1/3/2019 11/ 26/ 2018 RO-10

CERTIFICATION

This is to certify that the information contained in this form are true, correct and complete.

ENGR. ROLAND B. CAINHOG

Highest Ranking HRMO

Date: ___January 22, 2019____

REMARKS/COMMENTS/RECOMMENDATIONS: (e.g. Reasons for Disapproval of Appointment)

Regulated Agencies Only

CSC ACTION

Agency
Date of Receiving
Date of Action
Release Officer
(mm/dd/yyyy)
(mm/dd/yyyy)

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 CHECKLIST OF COMMON REQUIREMENTS HRMO
Instructions: Put a check if the requirements are complete. If incomplete, use the space provided to indicate the name of appointee and the lacking requirement/s.

APPOINTMENT FORMS (CS Form No. 33-A, Revised 2017) - Three (3) original
1 copies of appointment form (employee copy, CSC copy and agency copy)

PLANTILLA OF CASUAL APPOINTMENT (CSC Form No. 34-A or C) - Three (3)

2 original copies (employee copy, CSC copy and agency copy)

3 PERSONAL DATA SHEET (CS Form No. 212, Revised 2017)

ORIGINAL COPY OF AUTHENTICATED CERTIFICATE OF ELIGIBILITY/

4 RATING/ LICENSE - Except if the eligibility has been previously authenticated in
2004 or onward and recorded by the CSC

5 POSITION DESCRIPTION FORM (DBM-CSC Form No. 1, Revised 2017)

6 OATH OF OFFICE (CS Form No. 32, Revised 2017)

7 CERTIFICATE OF ASSUMPTION TO DUTY (CS Form No. 4)

This is to certify that I have checked the veracity,

authenticity and completeness of all the requirements in
support of the appointments attached herein.

ENGR. ROLAND B. CAINHOG

Highest Ranking HRMO
 CSC FO
me of appointee and the lacking requirement/s.

This is to certify that I have checked all the

requirements in support of the appointments attached
herein and found these to be [ ] complete / [ ] lacking.

____________________________________
CSC FO Receiving Officer
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