Annex A1

CSC-QUIRINO FO - May 14, 2025 - 13:00:00 - 14:00:00 - 25051420656300944140

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) ID PHOTO
To be filled out by Applicant To be filled out by Applicant - Philippine passport size
CSC Regional Office - showing 80% face capture
Examination Applied for: - in bare face & showing left
______________________________
REGION 2
and right ears
Career Service-Professional Date of Examination (mm/dd/yyyy)
- with handwritten (not
0 8 1 0 2 0 2 5 computer generated) name
First time to take the examination? : X YES NO
Place of Examination tag showing signature over
If NO, indicate date of last examination taken: ______________________________
DIFFUN, QUIRINO printed full name
(see illustration & more
(mm/dd/yyyy) Verified against: (For CSC Processor ONLY)
specifications at the back)
DIBAR E-Retakers EDQIS

Instructions : READ ADMISSION AND APPLICATION REQUIREMENTS AT THE BACK PAGE. DO NOT APPLY IF NOT QUALIFIED.
Fill in all the required information. DO NOT leave an item blank. If item is not applicable, indicate “N/A”.

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)
ALVAREZ GLENN III FERNANDEZ F
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

X Male Female
26 03/13/1999 SANTIAGO ISABELA
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 FERNANDEZ GLORIA FUENTES
COMPLETE PERMANENT MAILING ADDRESS ZIP CODE
#415 SITTIO ILUT CAQUILINGAN CORDON ISABELA,CORDON,ISABELA,REGION 2 3312
CIVIL STATUS OTHER DATA: If PWD, please specify: Orthopedic Deaf/hard of hearing
X Single Married Others _____________________
X Pregnant Senior Citizen Visually impaired Others ___________________________________________

MOBILE NUMBER (Required) TELEPHONE NUMBER (include Area Code) E-MAIL ADDRESS (Required)
+63994135167 N/A glenniiialvarez0313@gmail.com

Level of Education: High School/Sr High School Technical/Vocational College Postgraduate (Master/Doctor) Other/s: _______________________________

Completion: If not graduated/ongoing, highest Year/Level/Units earned, or taking up: ___________________________________

N/A
Not Graduated / ongoing
X Graduated If graduated, date/year of Graduation/Completion: _______________________
AUGUST 5 2022 Honors received: N/A
______________________________
BACHELOR SCIENCE IN BUSINESS ADMINI-
Complete Title of Course/Degree (except for High School/Sr High School): STRATION MARKETING MANAGEMENT
___________________________________________ Major: ______________________________________
ISABELA STATE UNIVERSITY MAIN
Name and Address of School Attended:SAN
_______________________________________________________________________________
FABIAN ECHAGUE ISABELA 2018-2022
Inclusive years: ______________________
(from-to)

Title of Examination Passed / Title of Eligibility Granted Rating Obtained Date of Examination / Place of Examination
Date Eligibility was Granted

N/A N/A N/A N/A

N/A N/A N/A N/A

Government Private Non-government Organization Self-Employed X Unemployed

No. of Years in Present Status of Appointment/

Agency/Office Address Position/Job Title
Position/Job Employment

N/A N/A N/A 0 N/A

DO NOT FILL-OUT THE SHADED PORTION. (FOR CSC PROCESSOR ONLY).

Date: ________________
Identification/Other Documents Presented: _______________________________________ Details: ______________________________________
O.R. No. _____________
ACTION TAKEN: APPROVED DISAPPROVED Reason for disapproval: ________________________________________
Amount: _____________

_____________________ _____________________________________________ ___________________________________ ______________________________

Name of Collecting Officer Signature over Printed Name of Processor Position/Designation Date & Time

APPLICATION NO. _______________________

Date: ________________

O.R. No. _____________

Amount: _____________ Examination Applied For: Career Service-Professional ID PHOTO
DATE: _________________________________
August 10, 2025 TIME: 06:30
__________
AM PLACE:DIFFUN,
______________________________
QUIRINO - Philippine passport size
_____________________
Name of Collecting Officer - showing 80% face capture
___________________________________ ______________________________ ___________________________ - in bare face & showing left
Signature over Printed Name of Processor Position/Designation Date & Time
and right ears
- with handwritten (not
GLENN F ALVAREZ III
Applicant’s Name: _________________________________________________________________________________________________________ computer generated) name
Given Name MI Last Name Ext. Name (i.e. Jr./Sr., if any) tag showing signature over
Sex: X Male Date of Birth (mm/dd/yyyy): 03/13/1999 Signature: ________________________
printed full name
Female
(see illustration & more
specifications at the back)
 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.

GLENN F ALVAREZ III

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

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

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.