request for filling-up permanent position · pursuant to: (a) indigenous people's act (ra...

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: _____________________


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)

/ /

/ /

25. NAME OF CHILD (Write full name and list all)

/ /

20. E-MAIL ADDRESS (if any)

/ /

DATE OF BIRTH (mm/dd/yyyy)

/ /

/ /

/ /

/ /(Continue on separate sheet if necessary)

22. AGENCY EMPLOYEE NO.

23. TIN

| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

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.

| | | | | | | | | | | | | | | | | |

DATE OF BIRTH (mm/dd/yyyy)

/ /

/ /

/ /

/ /

SCHOLARSHIP/ ACADEMIC HONORS

RECEIVED

ELEMENTARY

SECONDARY

VOCATIONAL / TRADE COURSE

Annulled

Others, specify ___________

Single

Married

Widowed

Separated

Male Fem ale

of 4

GRADUATE STUDIES



29.

NUMBERDATE OF RELEASE

30.

To

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

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

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)

/ /

POSITION TITLE (Write in full)

INCLUSIVE DATES (mm/dd/yyyy)

From

/ /

/ /

MONTHLY SALARY


V. WORK EXPERIENCE (Include private employment. Start from your current work)

/ /

/ /

/ /

STATUS OF APPOINTMENT

GOV'T SERVICE (Yes / No)

SALARY GRADE & STEP

INCREMENT (Format "00-0")

/ /

/ /

CS FORM 212 (Revised 2005), Page 2 of 4

/ /

/ /



From To

/ / / /

/ / / /

/ / / /

/ / / /

From To

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

33. SPECIAL SKILLS / HOBBIES: 34. 35.


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)


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)

request for filling-up permanent position · pursuant to: (a) indigenous people's act (ra...

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