PAGASA Public Files



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PAGASA Training Application Form

|Full Name: |

|(Last) (First) (Middle) |

|Sex: |Age: |Civil Status: |

|Date of Birth: |Place of Birth: |

|(dd/Mo/Yr) | |

|Residence Address: |Tel. No.: |

|Mailing Address: |

|Present Position / Item: |

| |

|Assigned / detailed at: |Division: |Section / Service: |Agency: |

|Status of employment: |Number of years in service: |Office Tel. no: |

|A. EDUCATIONAL ATTAINMENT (pls. present original college transcript of records and provide xerox copy) |

| |School/University/College/Institute |Course/Degree obtained |Date of Attendance |

|Elem. | | | |

|High School | | | |

|College | | | |

|Voca-tional | | | |

|B. TRAINING (SEMINARS, WORKSHOPS, FELLOWSHIPS & SPECIAL STUDIES COMPLETED) |

|Title of Training |Date of Attendance |Conducted by |Training |

| | | |Hrs. |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

(Continue on separate sheet if necessary)

|C. ELLIGIBILITY (IES) (Career Service/Professional Board/Bar Exam) |

|Title of Exam |Place of Exam |Date Taken |Rating % |

| | | | |

| | | | |

| | | | |

|D. RECORD OF SERVICE |

|From |To |Position |Office |Status of appointment |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

(Continue on separate sheet if necessary)

|1. Are you willing to accept assignment to any PAGASA field station? | | |

| If yes, state your priorities: | |

|2. Are you related within the 3rd degree of affinity or consanguinity to any PAGASA personnel or to the person who has direct |

|supervision over you in the office or Department you are appointed to be? ____________________ |

| If so, to whom? | |

|3. Have you ever been convicted for violating any law, decree, ordinance or regulations, by any court or tribunal? __________________ |

|4. Have you ever been convicted for any breach of infraction by a military, naval or constabulary tribunal or authority, or found |

|guilty of an administrative offense? _________________ |

| If yes, give particulars: | |

|F. Personal References |

|Name |Address |

| | |

| | |

| | |

| |

| I certify that the foregoing statements are true and complete to the best of my knowledge and understand that any false statement |

|is sufficient to cause rejection of the application. |

|Date accomplished: | | | | | |

| | Signature over printed name |

| |

|NOMINATION |

| | | |

| |Date: | |

|I hereby nominate Mr/Ms | |to attend the |

| |

| |(Title of the Training Course) | |

|The purpose/objective of which is relevant to his/her actual/ proposed responsibilities. |

|Recommending Approval: | |

| | |

| |(Section Chief) |

|APPROVE/DISAPPROVE | |

| | |

|(Division Chief) | |

“tracking the sky . . . helping the country”

-----------------------

RDTD-F-102

REPUBLIC OF THE PHILIPPINES

Department of Science and Technology

Philippine Atmospheric, Geophysical and

Astronomical Services Administration (PAGASA)

Science Garden Complex, Agham Road, Diliman, Q.C. 1100

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