CS Form No.

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

Report for the Month of:

INDIVIDUAL INFORMATION
NAME
OCCUPATIO
DATE AND PLACE
SEX N
NAME OF BIRTH
LAST NAME FIRST NAME MIDDLE NAME MAIDEN NAME CATEGORY
EXTENSION
OM ENTERING SERVICE
NS (DIBAR)

DATE & PLACE OF ELIGIBILITY /

POSITION AGENCY
EXAM RATING

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 DECISION INFORMATION*

DOCUMENT TYPE/ NO./

SIGNATORY POSITION AGENCY
DATE

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

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

Prepared by: Certified Correct:

Chief/Head of Division
(Signature over Printed Name)

Date: Date:
TION*

OFFENSE PENALTY REMARKS

government service and taking civil service examinations

Director IV/Head of Department or Office

(Signature over Printed Name)

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