(mm/dd/yyyy) NUMBER OF HOURS Type of LD ( Managerial/ Supervisory/ Technical/etc) CONDUCTED/ SPONSORED BY (Write in full) NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)
34.Bureau or Department where you will be apppointed,a. within the third degree? 35.a. Have you ever been found guilty of any administrative offense?atus of Case/s: 36. If YES, give details (country): 40. If YES, please specify ID No: 41.NAMEADDRESSTEL. NO.42.PHOTO Government Issued ID/License/Passport Signature (Sign inside the box) Date/Place of Issuan Date Accomplished Right Thumbmark AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indi Person Administering Oath CS FORM 212 (Revised 2017), Page 4 of 4 Are you related by consanguinity or affinity to the appointing or recommending authority, or to thechief of bureau or office or to the person who has immediate supervision over you in the Office, b. within the fourth degree (for Local Government Unit - Career Employees)?If YES, give details: ________________________________
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- Winter '17
- PRC, Family name, surname, Jr., Barangay