"A youl by oonsanguniy or ainiy Be appining or recommend auhory, roe ‘che of buroa orfca r to ho parson who has mmole supaision ver youn the Oc, Bureau or Degrtrent wee you willbe poi, 2. wt ho thi gro? bwin the fourth degree (fr Local Goverment Unt-CarerErpoyoesy? "a & Fave you ver oon ound guy of any erie ofersa?™ 'b. Have you been criminaly charged befor ay cout? Ow Gr TIVES, ae deta: ‘ate Fed ‘Stas of Cava [Have au eve ben Ooiid of any ee or wlan of any law, dee, ordnance or equation by ‘any cout ort? O vs TAYES, give details "Fr Have you ever been separated Wem a Savi nay oe lowing adores, rrment topped far te ro, dma, ein, ond f tn, fished contacter phased ou (tolten mn th puble opiate seco? Ove Hn TyeS, gve deta: “Bra Have you ever been cana a anal roa Scion had wit te es year except Barangay alocon)? », Hove you reigned from fhe goverment snicecung to tee (3}onth pete belo the st ‘eaten to prmotelactvely campaign fora rational or eal anda? TTYES, go dota Tp Have you acid he Sas fan nigra x ponvanen reste fancier county? ves 10 |HYES, give deta (coun): "A Pursuant) aigonous People Ac (RA B37; Magna Cra for Dsabled Persons (RATT), ‘and (Soo Parents Weta Act of 2000 (RA 8972), please answer theolonirg ews: Jase youa member fay ndigeous our? >. are youa person wih ait? }= Are youa slo paren? “_REFERENGES (Penney crea a pt pe) a v8, Bese spety: & Owes If YES, lees spety 1D No 3’ Ov YES, ase specy 1D No Tae = Te RAFAEL S. REGULAR MAA AOD Local Teast ALVINY. CANDELARIA WaA-cH00 local 285679860 REYNALDO A. LONTOC, AA A059 Loca 25787048 ‘autor th agen healatharzed representa ovale the contents statod herein egansime. Tascam Gs sR De (SE NDICATEIO Narr rd of suaoe "ET delve onde at at have prsnalysesoNpIahed Tis Posonal baa Sel whic Sa fue, coe ad compel ‘atamont pursuent to te provisions of pernant laws, rues and equains ofthe Repub ofthe Philippines | ristepresentaton rade in this docurent and is tachment sal cause the fing ofedminisetirelaminal cases Soe 1 agree at eny a ea ro ‘SUBSCRIBED AND SCR eto meis_ afin iting hier ales govern 1 sinsaled ebove.