Annex A1

CS FORM No. 100, Revised 2023. This Form is NOT for sale. Reproduction is allowed. APPLICATION NO. _______________

APPLICATION FOR CIVIL SERVICE EXAMINATION

(Pen and Paper Test)
To be filled out by Applicant To be filled out by Applicant

Examination Applied for:

ID PHOTO Instructions : READ
- Philippine passport size ADMISSION AND APPLICATION
Career Service-Professional - showing 80% face capture REQUIREMENTS AT THE BACK
- in bare face & showing left PAGE. DO NOT APPLY IF NOT
QUALIFIED.
First time to take the examination? : x YES NO and right ears
Fill in all the required
If NO, indicate date of last examination taken:
- with handwritten (not information. DO NOT leave an
Verified against: (For CSC Processor
item blank. If item is not computer generated) name
ONLY) applicable, indicate “N/A”.
(mm/dd/yyyy) tag showing signature over
DIBAR E-Retakers EDQIS
printed full name
(see illustration & more
specifications at the back)
CSC Regional Office

______________________________
CSC Regional Office I
Date of Examination (mm/dd/yyyy)
0 3 0 2 2 0 2 5
Place of Examination

______________________________
CANDON CITY, ILOCOS SUR

NAME (Last Name) (Given Name) (Ext. Name, e.g. Jr./Sr., if any) (Middle Name) (M.I.)
(e.g. De La Paz = D, P,
or DLP; Dela Paz = D, P, or DP)

HUFEMIA REX BRYAN GABAYAN G.

AGE DATE OF BIRTH (mm/dd/yyyy) SEX PLACE OF BIRTH: City (write province only if city name has namesake e.g. San Fernando City, La Union/City of San Fernando, Pampanga; OR

Municipality & Province

21 10/10/2003 x Male Female

CANDON CITY
CITIZENSHIP MOTHER’S MAIDEN FULL NAME (the full name of your mother by birth or before she was married)
(Last Name) (Given Name) (Middle Name)

FILIPINO
HUFEMIA VIOLETA GABAYAN
COMPLETE PERMANENT MAILING ADDRESS ZIP CODE
BUTOL, SANTIAGO, ILOCOS SUR 2707
CIVIL STATUS OTHER DATA
: If PWD, please specify: Deaf/hard of hearing
Orthopedic
Single Married Others _____________________ Pregnant Senior Citizen
x Visually impaired Others ______________________________
_____________

MOBILE NUMBER (Required) TELEPHONE NUMBER (include Area Code) E-MAIL ADDRESS (Required)

09273107016 N/A lengamata14@gmail.com

High School/Sr High School Technical/Vocational Postgraduate (Master/Doctor)

Level of Education:
x College Other/s: _______________________________

Completion: x If not graduated/ongoing, highest Year/Level/Units earned, or taking up: ___________________________________3RD YEAR
Not Graduated / ongoing

Graduated If graduated, date/year of Graduation/Completion:

_______________________ Honors received: ______________________________ N/A N/A
Complete Title of Course/Degree (except for High School/Sr High School): ___________________________________________ Major: _BACHELOR OF SCIENCE IN
POLITICAL SCIENCE CMC_____________________________________

Name and Address of School Attended: _______________________________________________________________________________ InclusiISPSC MAIN CAMPUS ve years:
______________________2021-2024
(from-to)

A. Place of Examination (School/Testing Venue Assignment) - shall be announced through the Online Notice of School Assignment (ONSA), available via the CSC website
www.csc.gov.ph approximately 2 weeks before examination day. If ONSA cannot be accessed, visit or call and inquire directly with the CSC Regional/Field Office where the examinees
filed their application. A complete directory of CSC Regional/Field Offices nationwide is available at the CSC website.

B. Ocular Inspection - visit and conduct an ocular inspection of the assigned school/testing venue at least 1 day before the exam day to be familiar with the school location

C. Failure to come on scheduled examination will mean forfeiture of examination fee and slot. Rescheduling of examination date is NOT allowed.

D. THINGS TO BRING ON EXAMINATION DAY [Note: Examinees are (i) advised to bring ONLY the items listed below, (ii) encouraged to use transparent bag, and (iii) to check related
Exam Advisory for additional and/or updates on Things to Bring on Exam Day.]
1. I.D. card, preferably the same I.D. card presented during filing of application (NO I.D., NO EXAM)
2. BLACK BALLPEN/S (note: Pencils and any other kinds of pen such as gel pen, sign pen, fountain pen, friction pen, etc. including other colors of ball pen are not allowed)
3. Original of PSA/LCR issued Birth Certificate (only if I.D. card has no date of birth)
Note: Examinees may opt to bring water, or preferred beverage (except alcoholic beverage) placed in clear/transparent container, and/or candies/biscuits (subject to inspection by the
Room Examiner/Proctor)

E. Wear proper attire on exam day, preferably plain white shirt/tops. SLEEVELESS SHIRT/BLOUSE, SHORTS/SHORT PANTS, TOKONG PANTS, RIPPED JEANS, and SLIPPERS
ARE NOT ALLOWED. Long hair (for both male and female) must be tied in “ponytail.”

F. Cellular phones and calculators are NOT ALLOWED in EXAMINEE’S SEAT, and any other gadgets including smart phones/watches and pens/eyeglasses with built-in camera,
wristwatches with calculator, books and other forms of printed materials, and any other items/tools/aids that would facilitate answering the test questions. In this regard, before
occupying the assigned seat, examinees shall deposit said items and their bags and all other personal belongings in front of the room or in the designated area. NO BELONGINGS
SHOULD BE PLACED UNDER THE EXAMINEE’S SEAT.
 IMPORTANT: Access, read thoroughly, and understand fully the EXAMINEE’S GUIDE on the conduct of the exam.

Annex A1

E. DECLARATION

I declare that I personally accomplished this application form, and I certify that the information given are true, correct, and complete
statements pursuant to the provisions of pertinent laws, rules, and regulations of the Republic of the Philippines. Further, I declare that I
meet and am compliant with ALL the admission requirements for the examination herein applied for, as enumerated below.

I understand that the acceptance and approval of my application for the examination is based on the information I provided. Further, I
understand that: 1) as a result of randomization procedure, I may and am willing to be assigned at any testing venue within the testing
center; and 2) the information I provided herein shall be handled and used, particularly for policy development/review/research/study
purposes, according to appropriate provisions of RA No. 10173 or the Data Privacy Act of 2012. Finally, I understand that the CSC
determines high answer similarities in the processing of test results, and conducts necessary investigation.

I therefore agree that: 1) in case a post-verification yields information contrary to what is declared, my application shall be disapproved,
and my payment forfeited; 2) any misrepresentation made in this document shall cause the invalidation of the result of this examination
and/or the filing of administrative/criminal case/s against me; and 3) in case my test results be found to have high answer similarities with
other examinee/s, the same shall be withheld pending the outcome of the investigation to be conducted by the CSC. Finally, I agree that
my examination shall not be processed and be considered null and void, or my test results shall be cancelled, in case a post-examination
verification shows that I violated Republic Act No. 9416 (Anti-Cheating Law), specifically the
unauthorized possession of the test booklet, or any examination related forms/materials, including
bringing of the same outside of the testing room/venue.

__________________________________________________________________ _____________________________________
Signature over Printed Name of Applicant Date

Note: (For personal/in-person filing only)

Spaces for Signature/Printed Name and Right Thumbmark of applicant should be left blank. These shall only be accomplished in the presence of the CSC Processor. Right
Thumbmark

1. Must be Filipino citizen; 1. Fully accomplished Application Form;

2. Must be at least 18 years of 2. Four (4) pieces of identical I.D. pictures with specifications, as follows:
age on the date of filing of • Philippine passport picture size (4.5 cm x 3.5 cm or 1.78” x 1.38”)
application; • taken within the last three (3) months prior to filing of application
• colored, with white background and printed on good quality photo paper (no peeling off)
3. Must be of good moral • in standard close-up shot (from shoulder level up with the head and face occupying at least 80% of the picture and with the name tag positioned at
character; approximately 1 inch or 2.54 cm. below the chin)
4. Must have not been • in bare face (no eyeglasses; no colored contact lens; no headdress, no bandana, or any accessories that may cover the facial features; facial
convicted by final judgment features not computer enhanced)
of an offense or crime • showing left and right ears
involving moral turpitude, or • taken in full-face view directly facing the camera, with neutral facial expression and both eyes open
disgraceful or immoral • with handwritten (not computer-generated) name tag legibly showing signature over printed full name which includes: Given Name, Middle Initial (if
any), Last Name, and Extension
conduct, dishonesty, Name (if any)
examination irregularity,
drunkenness or addiction to
drugs; Shot must be
5. Must have not been
from shoulder
dishonorably discharged
level up, with
from military service or
dismissed for cause from any head and
civilian positions in the face
government; and occupying at Name tag
6. Must have not taken the least approx. 1 inch
same level of Career Service the picture or 2.54 cm
Examination, regardless of below the chin
mode, within three (3) 3. Original and photocopy of any of the following I.D. cards, which is valid (not expired upon filing of application): Driver’s
months before the date of License/Temporary Driver’s License (LTO O.R. must be presented together with old Driver’s License; O.R. alone is not allowed)/Student Driver’s
examination. Permit; Philippine Passport; PRC License; SSS I.D.; GSIS I.D. (UMID); Voter’s I.D./Voter’s Certification; BIR/Taxpayer’s I.D.
(ATM
NOTE: a) Approval of type/TIN card type with picture);
PhilHealth I.D. (must have the bearer’s name, clear picture, signature and PhilHealth number) ; Company/Office I.D.;
applications may be School I.D.; Police Clearance/Police Clearance Certificate; Postal I.D.; Barangay I.D.; NBI
recalled any time upon Clearance; Seaman’s Book; HDMF Transaction I.D.; PWD I.D.; Solo Parent I.D.; Senior Citizen’s I.D.; CSC Eligibility Card;
discovery of and Philippine Identification (PhilID) Card. (Note: All other ID cards NOT included in the list shall NOT be accepted).
applicant’s 4. Applicable examination fee
disqualification, for
which the examination OTHER/ADDITIONAL REQUIREMENTS, as applicable:
fees paid shall be - Original and photocopy of Birth Certificate issued by the Philippine Statistics Authority, or the Local Civil Registry (only for applicants without
forfeited. date of birth in their I.D. card/s)
b) Applicants holding dual - Original and photocopy of Identification Certificate (IC) issued by the Bureau of Immigration (only for applicants holding dual citizenship under
citizenship under R.A. 9225 R.A. 9225, and those recognized as citizens of the Philippines under Sec 1, Article IV of the 1987 Philippine
(Citizenship Retention and Constitution)
Re-acquisition Act of 2003),
and those recognized as
citizens of the Philippines
under Sec 1, Article IV of the
1987 Philippine Constitution,
may apply for and take the
examination upon
presentation of necessary
documents, and meeting of all
the other admission and
application requirements for
the examination.
c) Applicants with pending
administrative and/or criminal
cases may take the
examination and shall be
conferred the eligibility if they
successfully pass the same.
However, this is without
prejudice to the outcome of
their pending cases. If they
 are found guilty, their eligibility
shall be forfeited based on the
penalties stated in the
decision and under existing
Civil Service Law and rules.
d) The Bar examination given by
the Supreme Court of the
Philippines and the Board
examinations (requiring
completion of at least a
bachelor’s degree) given by
the Professional Regulation
Commission are declared civil
service examinations under
RA No. 1080. Accordingly, and
under CSC Resolution No. 90-
1212, the passers are
automatically considered as
civil service eligibles. Along
this line, based on RA No.
10635, passers of the
examination for marine deck
and engine officers given by
the Maritime Industry Authority
are considered as falling
under the contemplation of RA
No. 1080. Thus, they may opt
NOT to take the Career
Service (Professional)
examination. Also, passers of
the Career Service
Examination for Foreign
Service Officer, and grantees
of the following eligibilities
under special laws and CSC
issuances may opt NOT to
take the Career Service
(Professional) examination:
Honor Graduate Eligibility
under P.D. 907; Scientific and
Technological Specialist
Eligibility under P.D. 997;
Sanggunian Member Eligibility
(Second level) under RA No.
10156; and Foreign School
Honor Graduate Eligibility
under CSC Resolution No.
1302714.

Please check related Examination Announcement for additional and/or updates on admission requirements and/or application requirements.