BC CSC Form 1
BC CSC Form 1
BC CSC Form 1
171
INFORMATION SHEET CSC FORM 1 (1960) REVISED
3. In-Service Trainings:
Course Date & Hour Training Agency Conducting
2010 PASS-NCR Division Seminar on Disaster Preparedness 07/23/2010 8 Div. of Pasig City
N.B. Each candidate for appointment or promotion shall accomplish this Supplementary Information Sheet
as well as the Information Sheet for Purposes of Administrative Order No. 171 and C.S. Form 11
(1960). Revised irrespective of the position and range to which be / she being Considered for
appointment or promotion
nments, etc.)
2. City: 7188 Jennys Ave. 4F2 Eusebio Provincial Address: Lagundi, Morong, Rizal
Bliss Vill., Maybunga, Pasig City
3. Birthdate: 7/29/1948 Place: Morong, Rizal
Management Training
10. Record of Services in the government (Include date of original appointment as well as subsequent ones, including
the last promotion)
NONE
13. In what particular line of services can you be the most useful?
14. Are you related to anybody in the office in which the position you aspire for belongs? If so, state the degree of
relationship.
No
15. Have you been accused or convicted in the court of any crime or are there any criminal or administrative case
filed against you in the court of any government agency? If so, give particulars:
No
16. Have you been retired under any retirement law or separated from the service?
No
17. Reference: Give names, address and occupation of the reliable persons (not related to you who could vouch for
integrity and honesty).
I hereby certify under oath that the foregoing statements are true and correct.
BENJAMIN C. JACOSALEM
Administrative Officer V
REPUBLIC OF THE PHILIPPINES 1. NAME OF EMPLOYEE
BC-CSC Form No. 1 :
ALBAY REGINA RAYMUNDO
: (Family Name/Given Name/Middle Name)
6a. Pres. Approp. : 6b. Prev. Approp. :7a. Salary 7b. Other Compensation
ACT ACT
Board Res. Board Res. : Authorized
Ord. No. Ord. No.
Item No. Item No. : Actual
12. For Local Government Position, Check Government Unit and Unit's Class
13. Statement of Duties and Responsibilities. (If more space is needed please attach additional sheets.)
Percent DUTIES
16. Names, Titles and Item Nos. of those you Directly Supervise
28 TEACHERS , 14 UTILITY WORKERS INCLUDING GUARDS
19. I CERTIFY that the above answers are accurate and complete.
22a. Indicate the required qualification by years and kind of Education considered
in filling up a vacancy for the position. (Keep the position in mind rather than
the qualifications of the present incumbent. This item should be filled for all
position other than teaching).
Education:
Education:
23. I hereby CERTIFY that the above answers are accurate and complete.
24. APPROVED: