request for filling-up permanent position · cs form 212 (revised 2005) ... 2 csc form no. 211 -...
TRANSCRIPT
SILANG WDADM-HRD-F001
Requisitioning Division :
No. of Position Requested :
Position Title :
Salary Grade :
Item No. :
Justification/s:
Duties to be Performed:
Requested by: Recommended By: Approved by:
Dept./Div. Manager Division Manager - HR General Manager
Date: Date: Date:
REQUEST FOR FILLING-UP PERMANENT POSITION
SILANG WD ADM-HRD-F002
REQUEST FORM FOR PERSONNEL
Requisitioning Division: ________________________________________________________
No. of Positions Requested: _____________________________________________________
( ) Helper ( ) Job Order
Position Title: _________________________________________________________________
Duties to be Performed:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Justification/s:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Requested Date to Start: ________________________________________________________
Approved Date to Start: ________________________________________________________
Requested by: Recommended by: Approved by:
______________________ ____________________________ __________________________
Dept./Div. Manager C Division Manager C – HR General Manager
Date:_________________ Date: _______________________ Date: _____________________
SILANG WDADM-HRD-F012
2. SURNAME
FIRST NAME
MIDDLE NAME
4.
5. PLACE OF BIRTH
6. SEX
17. TELEPHONE NO.
8. CITIZENSHIP
9. HEIGHT (m)
10. WEIGHT (kg)
11. BLOOD TYPE
12. GSIS ID NO.
13. PAG-IBIG ID NO.
14. PHILHEALTH NO.
15. SSS NO.
24. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
26.
27.
From To
CIVIL STATUS
(Continue on separate sheet if necessary)
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25. NAME OF CHILD (Write full name and list all)
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20. E-MAIL ADDRESS (if any)
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DATE OF BIRTH (mm/dd/yyyy)
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/ /(Continue on separate sheet if necessary)
22. AGENCY EMPLOYEE NO.
23. TIN
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16. RESIDENTIAL ADDRESS
3. NAME EXTENSION (e.g. Jr., Sr.)
HIGHEST GRADE/ LEVEL/
UNITS EARNED (if not graduated)
MOTHER'S MAIDEN NAME
SURNAME
FATHER'S SURNAME
FIRST NAME
FIRST NAME
MIDDLE NAME
LEVEL DEGREE COURSE (Write in full)
YEAR GRADUATED (if graduated)
MIDDLE NAME
PERSONAL DATA SHEET
CS FORM 212 (Revised 2005)
1. CS ID No. (to be filled up by CSC)Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary.
/ /
INCLUSIVE DATES OF ATTENDANCE
/ /
21. CELLPHONE NO. (if any)
ZIP CODE
19. TELEPHONE NO.
NAME OF SCHOOL (Write in full)
I. PERSONAL INFORMATION
7.
ZIP CODE
18. PERMANENT ADDRESS
II. FAMILY BACKGROUND
III. EDUCATIONAL BACKGROUND
COLLEGE
28.
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DATE OF BIRTH (mm/dd/yyyy)
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SCHOLARSHIP/ ACADEMIC HONORS
RECEIVED
ELEMENTARY
SECONDARY
VOCATIONAL / TRADE COURSE
Annulled
Others, specify ___________
Single
Married
Widowed
Separated
Male Fem ale
Page 1 of 4
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SILANG WDADM-HRD-F012
29.
NUMBERDATE OF RELEASE
30.
To
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CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE
DATE OF EXAMINATION / CONFERMENT
PLACE OF EXAMINATION / CONFERMENTLICENSE (if applicable)
RATING
IV. CIVIL SERVICE ELIGIBILITY
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DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)
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POSITION TITLE (Write in full)
INCLUSIVE DATES (mm/dd/yyyy)
From
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MONTHLY SALARY
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work)
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STATUS OF APPOINTMENT
GOV'T SERVICE (Yes / No)
SALARY GRADE & STEP
INCREMENT (Format "00-0")
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CS FORM 212 (Revised 2005), Page 2 of 4
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(Continue on separate sheet if necessary)
SILANG WDADM-HRD-F012
From To
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From To
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33. SPECIAL SKILLS / HOBBIES: 34. 35.
(Continue on separate sheet if necessary)
31.
VII. TRAINING PROGRAMS (Start from the most recent training.)
CONDUCTED/ SPONSORED BY (Write in full)
INCLUSIVE DATES OF ATTENDANCE (mm/dd/yyyy)32.
NAME & ADDRESS OF ORGANIZATION (Write in full)
INCLUSIVE DATES (mm/dd/yyyy) NUMBER OF
HOURS POSITION / NATURE OF WORK
NUMBER OF HOURS
NON-ACADEMIC DISTINCTIONS / RECOGNITION: (Write in full)
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full)
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
CS FORM 212 (Revised 2005), Page 3 of 4(Continue on separate sheet if necessary)
SILANG WDADM-HRD-F01236.
a.
b.
37
38.
39.
40.
41.
a.
b.
c.
42.
NAME ADDRESS
PHOTO
COMMUNITY TAX CERTIFICATE NO.
ISSUED AT
/ /ISSUED ON (mm/dd/yyyy) RIGHT THUMBMARK
TEL. NO.
REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
If YES, please specify: ____________________
If YES, please specify: ____________________
If YES, give details: ________________________________ ________________________________
Have you ever been a candidate in a national or local election (except Barangay election)?If YES, give details: ________________________________ ________________________________
Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
Are you a solo parent?
If YES, please specify: ____________________Are you a member of any indigenous group?
Are you differently abled?
If YES, give details: _____________________________________ _____________________________________ _____________________________________
a. Have you ever been formally charged?If YES, give details: ________________________________ ________________________________
Are you related by consanguinity or affinity to any of the following :
If YES, give details: _____________________________________ _____________________________________ _____________________________________
Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?
Within the third degree (for National Government Employees): appointing authority, recommending authority, chief of office/bureau/department or person who has immediate supervision over you in the Office, Bureau or Department where you will be appointed?
SIGNATURE (Sign inside the box)
43.
CS FORM 212 (Revised 2005), Page 4 of 4
DATE ACCOMPLISHED
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential.
I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
b. Have you ever been guilty of any administrative offense?If YES, give details: ________________________________ ________________________________
Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal? If YES, give details:
________________________________ ________________________________
Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the rolls, dismissal, termination, end of term, finished contract, AWOL or phased out, in the public or private sector?
ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size)
Computer generated or xerox copy of picture
is not acceptable
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
SILANG WD ADM-HRD-014
C. S. FORM 32
(PANTAGAPAGPAGANAP)
REPUBLIKA NG PILIPINAS
___________
PANUNUMPA SA KATUNGKULAN ___________
Ako, si ………………………………………..………………………………………. ng
………………………………………………………..…… na (hinirang/itinalaga) sa
katungkulan bilang ……….…………………………………………………………………….
………………………………......... ay taimtim na nanunumpa na tutuparin kong buong
husay at katapatan, sa abot ng aking kakayahan, ang mga tungkulin ng
aking kasalukuyang katungkulan at ng mga iba pang pagkaraan nito’y
gagampanan ko sa ilalim ng Republika ng Pilipinas, na aking itataguyod
at ipagtatanggol ang Saligang-Batas ng Pilipinas; na tunay na mananalig
at tatalima ako rito; na susundin ko ang mga batas, mga kautusang legal,
at mga dekretong pinaiiral ng mga sadyang itinakdang may kapangyari-
han ng Republika ng Pilipinas; at kusa kong babalikatin ang pananagu-
tang ito, nang walang ano mang pasubali o hangaring umiwas.
KASIHAN NAWA AKO NG DIYOS.
………………………………………………
Sedula, Klase……….Blg…………………
Kinuha sa ………………………………
Petsa …………………………………
________________________________________________________________________
Nilagdaan at pinanumpaan sa harap ko ngayong ika-…………... ng
………………………………………., A. D. sa ………………………………..…,
Pilipinas.
……………………………………………
016222
Magdikit ng isang
30-sentimong selyo doku-
mentaryo
SILANG WD
ADM-HRD-F017
Date : ____________________
Approved by: RATING SCALE:
5 - Outstanding
4 - Very Satisfactory
Date 3 - Satisfactory
2 - Unsatisfactory
1 - Poor
Q E T A
AVERAGE:
45%
AVERAGE:
45%
OFFICE PERFORMANCE COMMITMENT AND REVIEW ( OPCR)
I, _____________________________________, _____________________________________ of _______________________________________, commit to deliver and agree to be rated on the attainment
of the following targets in accordance with the indicated measures for the period __________________________________.
General Manager
MFOSuccess Indicators
( Targets + Measures )
Allocated
Budget
Division / Individuals
ResponsibleActual Accomplishments
RatingRemarks
SO I.
CORE FUNCTIONS
SUPPORT FUNCTIONS
Q E T A
MFOSuccess Indicators
( Targets + Measures )
Allocated
Budget
Division / Individuals
ResponsibleActual Accomplishments
RatingRemarks
AVERAGE:
10%
FINAL RATING
Assessed by: Date Final Rating by:
Strategic Priority
CATEGORY MFO
Core Functions
Support Functions
Total Overall Rating
Final Average Rating
Adjectival Rating
Date
General Manager, SWD General Manager, SWD
SILANG WD
ADM-HRD-F019
1.6.
2. 7.
3.
8.
4. 9.
5.
To increase the level of competencies of current position
CAREER DEVELOPMENT:
Noted By:
Division Head
Department Head
Years in SWD
PURPOSE:
CERTIFICATION AND COMMITMENT
Area for
Development
Short Term Training / Development Goals ( Next Year )
This is to certify that my competency assessment
and development plan has been discussed with me
by my immediate superior. I further commit that I
will exert time and effort to ensure that my
Individual Development Plan is achieved according
to agreed time frames.
Employee Name and Signature / Date
Immediate Supervisor Name and Signature / Date
Target
Completion Date
Priority for
IDPDevelopment Activity
INDIVIDUAL DEVELOPMENT PLAN
Target
Completion DateDevelopment Activity
Priority for
IDP
Training / Development Interventions for Long Term Goals ( Next Five Years )
Area for
Development
Department
Division
No further
development is
desired or required for
Immediate
Supervisor's Name
Name of
Employee
Current Position
Salary Grade
Years in the
Position
To increase the level of competencies of current position
CERTIFICATION AND COMMITMENT
Short Term Training / Development Goals ( Next Year )
Employee Name and Signature / Date
Immediate Supervisor Name and Signature / Date
Completion Status
INDIVIDUAL DEVELOPMENT PLAN
Completion Status
Training / Development Interventions for Long Term Goals ( Next Five Years )
SILANG WD ADM-HRD-F020
TRAINING NOMINATION FORM
Title of Training Program: ________________________________________________________
Duration of Training: ________________________ Equivalent # of Hours: _________________
Employee Nominated for Training: _________________________________________________
Name of Institution Handling the Training: ___________________________________________
( ) Accredited by CSC ( ) Non-Accredited Organization/Association
Justification/s for Nomination:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Recommended by: Verified as to Budget Appropriation:
________________________ ____________________________________
Division/Department Manager C Division Manager C – Budget & Planning
Date: ___________________ Date: _________________________
(TO BE ACCOMPLISHED BY HR DIVISION)
No. of Training Program/s Attended Within the Year: __________________________________
Related Program/s Attended in the Last Five (5) Years:
Date Attended Training Program
Checked by: Verified by:
___________________________ ____________________________________
Industrial Relations Management Officer B Division Manager C - HR
(TO BE ACCOMPLISHED BY THE OFFICE OF THE GENERAL MANAGER)
( ) APPROVED ( ) DISAPPROVED
As per Board Resolution No. __________________ Date: ______________________________
__________________________
General Manager
SILANG WATER DISTRICT QUALIFICATION STANDARD:
Silang, Cavite (POSITION TITLE)
Educational Requirement:
Experience Requirement:
Training Requirement:
Eligibility Requirement:
This is to certifiy that we have verified the qualification of the above-mentioned candidate for appointment to a permanent position. The PSB Committee endorsed the appointment of
Department/Division Manager
/ Immediate Supervisor
Chairman Member Member - First Level Representative
CERTIFICATION OF PROMOTION AND SELECTION BOARD
(Appointee) to the vacant position (POSITION TITLE)
(20%)
POTENTIAL TOTALREMARKS
FOR APPOINTMENT / PROMOTION SERVICE ELIGIBILITY (40%) (15%) (5%) (15%) & PERSONALITY TRAITS (5%) (100%)
BEHAVIORAL
NAME OF CANDIDATES APPROPRIATE CIVIL PERFORMANCE EDUCATION TRAINING EXPERIENCE CHARACTERISTICS
Job Order
Name:
Properly Accomplished Personal Data Sheet (with required picture)
Diploma
Transcript of Records
Certificate of Eligibility (CS Professional/Sub-Professional/SCEP)
PRC Licensure Examination Certificate
Certificate of Training/Seminars Attended
Certificate of Previous Employment and Clearance
Original Copy of NBI Clearance
Original Copy of Police Clearance
Original Copy of Barangay Clearance
Community Tax Certificate/Cedula
Medical Certificate
Blood Typing Chest X-Ray
Urinalysis Drug Test (Shabu & Marijuana)
Fecalysis
Birth Certificate issued by PSA
Marriage Contract issued by PSA (if married)
Birth Certificate of Dependent/s issued by PSA
1x1 Recent ID Picture (white background) ( pcs.)
3.5 cm x 4.5 cm Passport Size Picture (white background and name tag ex: JUAN M. DELA CRUZ )
( ____ pcs.)
Available ID:
PRC ID HDMF/Pag-IBIG Others:
Driver's License PhilHealth
BIR Passport
GSIS Postal
Issued by:
Date:
SILANG WATER DISTRICTSilang, Cavite
CHECKLIST OF REQUIREMENTS
Permanent
OTHER REQUIREMENTS FOR SUBMISSION:
1 Original & 1 photocopy of Previous Approved CSC Appointment (if previously connected with government)
2 PRC ID
3 Board Rating
4 Service Record (from previous employment)
5 Job Description Certified by Personnel Officer (from previous employment)
6 Clearance (money, property & other accountabilities with last employer)
7 Affidavit of Correction of Data, if any
HR Forms:
1 Personal Data Sheet
2 CSC Form No. 211 - Medical Certificate for Employment
3 1 Original Copy of Statement of Assets & Liabilities (notarized)