Identification and Disclosure Form

Guided by Memorandum Circular No. 21 series of 2012 or the Enhanced Guidelines on the Code of
Conduct for Personnel of the Department of Social Welfare and Development under Section V or the
Policy on Nepotism, it shall be the duty of DSWD Field Office VIII employees and personnel to
identify and disclose, to the best of his/her knowledge and information, his/ her relatives in the
Agency. Hence, this identification and Disclosure or Relative Form.

Section V States that:

a. Pursuant to Civil Service laws and rules on nepotism, no appointments in the career service
shall be made in favor of a relative of the appointing or recommending authority within the
third degree of affinity or consanguinity. For the purposes of this Code of Conduct, the same
policy is adopted and shall apply in hiring of MOA Workers considering that said workers
form part of the workforce of the Department;
b. In case of marriage betwee personnel of the same offcie, bureau or service, change of place
of assignment, reassignment or transfers of at least one of the personnel concerned shall be
done.

As defined in MC 21 s. 2012, “relatives” refers to any and all persons related to a public official or
employee within the fourth civil degree of consanguinity or affinity, including bilas, inso and balae.

DSWD FO VIII employees/ personnel shall be responsible for disclosing potential or existing
situations concerning employment of a relative to their supervisor and Human Resource Planning
and Performance Management Section. Non-disclosure may lead to disqualification and/or
ineligibility for employment, promotion, transfer or renewal of contract.

Employee’s Information

Name: ___Tiffany Jane A. Go__________________ Position: ___ Social Welfare Officer II ____

Area of Assignment:____RRPTP-CBWP________ Supervisor: Alice V. Viason- SWO IV, CBWP Head

__I do not have any relatives working in DSWD Field Office VIII
__I have relative/s working in DSWD Field Office VIII, as follows

1. Relative’s Name : ___________________________________

Area of Assignment : ___________________________________
Position: : ___________________________________
Relationship : ___________________________________

I hereby certify that to the best of my knowledge, the above-enumerated are names of my relatives
in the Agency within the fourth civil degree of consanguinity or affinity.

___________________________
SIGNATURE OVER PRINTED NAME