REPUBLIC OF THE PHILIPPINES

________________________)S.S

AFFIDAVIT

I, _________________________________,Filipino citizen, of legal age and residing at

__________________________________________________________, after having been sworn to in accordance
with law, hereby depose and say:

That I am applying for a position in the Commission on Audit, Commonwealth Avenue, Quezon City;

I. DECLARATION OF INFORMATION ON RELATIVES IN COA

That I have NO RELATIVES within the 3rd degree either of consanguinity and/or affinity who are presently
employed in COA;
That I have RELATIVE/S who is/are presently employed in COA, as follows:

NAME OF RELATIVE RELATIONSHIP POSITION NAME OF

OFFICE/SECTOR

(Use additional sheet, if necessary. Include in-laws, if any.)

II. DECLARATION ON RESIDENCY STATUS

I am not immigrant to/permanent resident of any foreign country;

I am an immigrant/permanent resident of ______________________.

(Name of Foreign Country)

That if my application for employment in the Commission on Audit is approved, I undertake to renounce my
oath of allegiance to the ___________________________ where I am an immigrant or permanent resident,
and to furnish the Human Resource Management Office, Administration Sector, this Commission
appropriate documents evidencing such renunciation before I assume my position.

I have a pending application as immigrant/permanent resident of _________________________.

(Name of Foreign Country)

That if my application for employment in the Commission on Audit is approved, I undertake to give up my
application as immigrant/permanent resident of _________________________.
(Name of Foreign Country)

III. ACCEPTANCE OF PLACE OF ASSIGNMENT

That I am willing to accept assignment anywhere in the exigency of the service, if appointed in the
Commission on Audit.
ACCEPTANCE OF LOWER SALARY/LOWER SALARY GRADE LEVEL

That in case I am presently employed, I am willing to accept:

Lower salary than my present salary
Lower salary grade level than my present salary grade level

V. INFORMATION ON PENDING APPLICATIONS

Please check the appropriate box below:

That I am applying for a position in the COA Central Office (National Capital Region), Commonwealth
Avenue, Quezon City. This is the first time I submitted my application in the COA (No previous application
in the Central Office or in any COA Regional Offices)
 That I previously filed my application for employment in COA:

In the COA Central Office on ____________________ and the status is:

Passed the exam on ________________ and is included in the pool of applicants

Failed the exam on ________________. Others (give details):______________
Pending evaluation of application documents

In COA Regional Office No. ________ on __________ and the status is:

Passed the exam on ________________ and is included in the pool of applicants

Failed the exam on ________________. Others (give details):______________
Pending evaluation of application documents
If my application will not be considered in the COA Central Office or in my preferred COA Regional Office
due to lack of vacancies, my application documents may be referred to the following Regional Offices:
(Please state in order of priority)

1. COA Regional Office No. ___

2. COA Regional Office No. ___
3. COA Regional Office No. ___
VI. ACCEPTANCE OF TEMPORARY APPOINTMENT (For Lawyer-applicants)

That I am willing to accept temporary appointment

I understand that continuing, undivided allegiance to the Republic of the Philippines is a continuing qualification as
an official or employee of this Commission.

That the above information shall be one of the bases in the evaluation of my application and can be ground for the
cancellation of the processing of my application if found to be non-compliant with the recruitment policies of the
Commission.

I understand that should I be employed, any misrepresentation or concealment of relevant information can be
grounds for an administrative case and termination.

That I hereby authorize the Commission and voluntary give my consent to COA to conduct further employment
verification and background investigation on me.

This affidavit executed to attest to the veracity of the foregoing statements.

IN WITNESS HEREOF, I have hereunto signed my name below this _____ day of _____ at
________________________________.

_____________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this ____ day of _______________________ in

_________________, affiant exhibiting to me his/her Residence Certificate No. __________________
Issued at _____________________ on ______________________.

______________________
Notary Public
Doc No. __________
Page No.__________
Book No.__________
Series of___________