CS Form No.

8
Revised 2017
REPORT ON DATABASE OF INDIVIDUALS BARRED FROM ENTERING SERVICE
AND TAKING CIVIL SERVICE EXAMINATIONS (DIBAR)
(Name of Agency)

Report for the Month of:

INDIVIDUAL INFORMATION
NAME
DATE AND PLACE OCCUPATION ELIGIBILITY /
SEX POSITION AGENCY DATE & PLACE OF EXAM
NAME OF BIRTH CATEGORY RATING
LAST NAME FIRST NAME MIDDLE NAME MAIDEN NAME
EXTENSION

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 DECISION INFORMATION*

DOCUMENT TYPE/
SIGNATORY POSITION AGENCY OFFENSE PENALTY REMARKS
NO./ DATE

*DECISION INFORMATION - Decision/Resolution/Order issued to bar certain individuals from entering government service and taking civil service examinations

I hereby certify that the Decisions/Resolutions/Orders enumerated are executory.

Prepared by: Certified Correct:

Chief/Head of Division Director IV/Head of Department or Office
(Signature over Printed Name) (Signature over Printed Name)

Date: Date:

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