Professional Regulation Commission

APPLICATION FOR REGISTRATION WITHOUT EXAMINATION

(VARIOUS BOARDS)

NAME OF BOARD MECHANICAL ENGINEERING

PERSONAL DATA
LAST NAME FIRST NAME MIDDLE NAME
Maci
nas Abram Vega 1½X1½
x MALE FEMALE
CIVIL STATUS
x
SINGLE MARRIED
PICTURE
WIDOWED SEPARATED
CITIZENSHIP DATE OF BIRTH (mm/dd/yy) PLACE OF BIRTH
Fi
li
pino 1 1 0 2 9 1 Daet,Cam Norte
PERMANENT MAILING ADDRESS
Purok7,Barangay Al
awi
hao,DaetCamari
nesNorte
ZIP CODE TELEPHONE/CELL PHONE NO/ EMAIL ADDRESS
4600 09397232338 / abram.maci
nas1210@ gmai
l.com
SPOUSE’S NAME & CITIZENSHIP FATHER’S NAME & CITIZENSHIP MOTHER’S NAME & CITIZENSHIP
N/A Orl
ando B.Maci
nas/ Fi
li
pino El
izabeth V.Maci
nas/ Fi
li
pino
Have you ever been convicted by final judgment before any court, military tribunal or administrative body? YES x NO
(If yes, please attach a copy of the decision)
EDUCATIONAL DATA
Name of School Location Course/Degree From TO
Completed (mm/dd/yy) (mm/dd/yy)
Elementary Teachers Vil
lage Elem.School Daet,Camari nes Norte N/A 06/01/1998 03/11/2004
High School Vi
nzonsPi
lotHi
gh School VinzonsCamarines Norte N/A 06/21/2004 03/27/2008
College Camari
nes Norte State Col
lege Daet,Camari
nes Norte B.S i
n MechanicalEngi
neeri
ng 06/01/2009 03/31/2016
Others
PREVIOUS LICENSURE EXAMINATION/S TAKEN
NAME OF EXAMINATION DATE TAKEN VERIFIED BY PRC ID
Record Section Registration Division YEAR EXPIRED

Mechani
calEngi
neeri
ng Board Exam Sept.28 -29,2016

EMPLOYMENT RECORD
FROM TO
OFFICE POSITION HELD SPECIFIC WORK/FUNCTION (mm/dd/yy) (mm/dd/yy)
Therma Mobi
le Inc.Aboi
ti
zPower Mechani
calAssi
stant Reponsi
ble forconducti
ng correcti
ve and preventi
ve mai 03/21/2017
ntenance 03/05/2018
Therma Mobi
le Inc.Aboi
ti
zPower Engi ne Room Operator Operate PlantEquipmentin accordance with operating parameters 03/06/2018 04/20/2019
Therma Mobi
le Inc.Aboi
tizPower ControlRoom EngineerImplementsstart-up,shutdown and loading ofalldieselgenerating units 04/21/2019 01/05/2023
Therma Mobi
le Inc.Aboi
tizPower OperationsSupervi
sor Responsible forthe safely,efficientlyand reliable plantoperations 01/06/2023 Present
ACTION TAKEN ACTION TAKEN BY THE BOARD I HEREBY CERTIFY that the information and/or
statements in this application including the documents
Remarks:________________ CHAIRMAN _____________________ submitted in support thereof are all true and correct to my
________________________ MEMBER _____________________ own knowledge, and that I am fully aware that any false
________________________ MEMBER _____________________ information or statement in this application and/or its
Processed by:_____________ MEMBER _____________________ attachments shall render me liable for criminal prosecution
Date:____________________ MEMBER _____________________ and/or administrative sanction.

ACTION TAKEN BY THE CASHIER

_______________________
Amount:_________________________ Date: ________________ Applicant’s Signature
O.R. No:_____________________ Issued by: ________________ THUMBMARK _______________________
Date Accomplished

Subscribed and sworn to before this________day of_______20____at _______, Affiant

Applicant entitled to me his Community tax Certificate No. _____________________ issued at DOCUMENTARY STAMP
_______________________on________________.
_____________________________
PRC ADMINISTERING OFFICER
…………………………………………………………………………………………………………………………………………………………………...

O.R. No. _________________ FOLLOW-UP SLIP

Amount Paid: _____________
Date Paid: ________________

NAME: _______________________________________ PROFESSION_________________________

DATE OF FILING: ______________________________
Please verify approval of your application and resolution number at the Application Division @
(02) 736-22-52 after 3 months or visit PRC website at www.prc.gov.ph (news & event)
____________________________
Application Processor/Date

APP-20-A
Rev. 00
May 31, 2016
Page 1 of 1
 STEPS IN FILING APPLICATION FOR REGISTRATION WITHOUT EXAMINATION

1. Fill-out application form together with the required documents for pre-evaluation to the Application Division (4th Floor, Annex
Bldg.) at the PRC Central Office and the Regional Offices processing counters.
2. Go to the Legal Division (2nd Floor, Main Bldg) for notarization
3. Go to the cashier for payment of fees. (Ground Flr., Main Bldg.)
4. Go to the Customer Service Center for documentary stamp (Ground Flr., Annex Bldg.)
5. Submit duly accomplish application form to the Application Division.
6. After three (3) months, verify status of application at Tel. No. (02) 736-2252

DOCUMENTS REQUIRED

CERTIFIED MINE FOREMAN RADIOLOGIC TECHNOLOGIST & 4. Lists of design undertaken with
X-RAY TECHNOLOGIST the supervision of a PME
1. Original and photocopies of 5. Curriculum Vitae
Transcript of Records/Diploma 1. Original and Photocopy of Birth 6. Two (2) titles of proposed reports
2. Original and Photocopy of Birth Certificate (NSO) each with a short write-up and table
Certificate (NSO) 2. Original and Photocopy of of content
3. Original NBI Clearance Marriage Certificate NSO (for 7. NBI Clearance
4. Certificate of Experience (PRC married female) 8. Current Professional ID as ME
Form 104) 3. Original and Photocopy of 9. Certificate of Competency
5. Certificate of Employment (at least Transcript of Records and Diploma 10. Affidavit of applicant
5 years) 4. Certificate of Experience (PRC 11. Certificate of Experience (APP-
Form No. 104) – for RAD. Tech. only 04)
METALLURGICAL PLANT 5. Certificate of Employment (for 12. Detailed Description of
FOREMAN private employees) – for RAD-Tech. Machineries and Equipment Handled
PLEASE SEE REQUIREMENTS only
FOR CERTIFIED MINE FOREMAN 6. Service Record (for gov’t PROFESSIONAL ELECTRONICS
employees) - for RAD-Tech. only ENGINEER
1. Original and Photocopy of birth 7. PART Certificate of Membership
certificate (NSO) 8. Original NBI Clearance 1. Valid PRC ID as Electronics Engineer or
2. Original and Photocopy of 9. Authenticated copy of Report of
Marriage Certificate NSO (for Rating from DOH-RHS Certificate as Electronics Engineer.
married female) 2. Valid IECEP ID or Certificate of
3. Original and Photocopy of PROFESSIONAL MEDICAL membership in good standing from IECEP.
Transcript of Records REPRESENTATIVE
3. Certified experience record of active self-
4. Original and Photocopy of College
diploma/High School diploma 1. Original & Photocopy of NSO Birth practice and/or employment either in
5. Duly notarized Service Record Certificate government service or in private sector, in
6. Duly notarized Certificate of 2. Original & Photocopy of Marriage
the format to be prescribed by the
Employment Certificate NSO (for Married female)
7. Certificate of Experience (APP-04) 3. Certificate of Employment Board,indicating the inclusive dates,
8. NBI Clearance 4. Certificate of Training companies worked for, description of specific
responsibilities, relevant accomplishments
CHEMIST PROFESSIONAL ELECTRICAL
ENGINEER and name, position of immediate
1. Original and Photocopy of Birth supervisor for a period of at least seven (7)
Certificate (NSO) 1. Original and Photocopy of years (inclusive and/or aggregate), at least
2. Original and Photocopy of Transcript of Records
Marriage Certificate NSO (for 2. Original and Photocopy of Birth two(2) years of which are in responsible
married female) Certificate (NSO) charge of significant engineering work, from
3. Original and Photocopy of 3. Original and Photocopy of the date the applicant took his/her oath as
Transcript of Records Marriage Certificate NSO (for
an Electronics and Communications
4. NBI Clearance married female)
5. Original and Photocopy of 4. NBI Clearance Engineers or Electronics Engineers.
Doctoral Degree Diploma 5. Valid certificate of registration and 4. Three (3) certification signed by three (3)
6. Copy of Thesis Professional ID as REE PECE attesting that the experience record
6. Certificate of Experience (APP-04)
MEDICAL LABORATORY submitted by the applicant is factual (not
TECHNICIAN PROFESSIONAL MECHANICAL needed for those who have been registered
ENGINEER and licensed as ECE under R.A. 5734, for at
flunkers with ratings of 70% or 1. Original and Photocopy of Birth
above) Certificate (NSO) least seven (7) years.
1. Report of rating (optional) 2. Original and Photocopy of 5. Original NBI Clearance (Private Sector)
2. Original NBI Clearance Marriage Certificate NSO (for 6. Original Ombudsman Clearance and NBI
3. Original and Photocopy of married female)
Clearance (for those in the government
Marriage Certificate NSO (for 3. Original and Photocopy of
married female) Transcript of Records service)

APP-20-A
Rev. 00
May 31, 2016
Page 2 of 1