SPES_SAF2013 Republic of the Philippines DEPARTMENT OF EDUCATION Center for Students and Co-C urricular Affairs SPECIAL PROGRAM

FOR THE EMPLOYMENT OF STUDENTS Control Number ______________ Self-Assessment Form I. PERSONAL INFORMATION Full Name Nickname Mobile No. Mailing Address Birthdate E-mail GENERAL REQUIREME NTS (Please check the box only if you have the photocopies of the following document s) Gender Landline No. Age II. FAMILY BACKGROUND Father's Occupation Mother's Occupation Status of Parents Living Together Separated Weekly Salary Estimate Weekly Salary Estimate Deceased Father Deceased Mother Both Deceased How many are you in the family? How many are married? Birth Order How many are working? Who is the breadwinner of the family? Who else supports the family financially? 2 x 2 Recent Photo Resume / Biodata Birth Certificate Income Tax Return (ITR) of both parents -------------- OR -------------Affidavit that the annual net incom e after tax of both parents does not exceed PhP 143,000.00 BIR Certification SPE CIFIC REQUIREMENTS III. EDUCATIONAL BACKGROUND School Course and Year Level Scholarships/Other Grants Supported by Tuition Fee For High School Students: Form 138 (preferably with 4th Grading marks) For Colle ge Students: Recent Grades School Registration For Out-of-School-Youth (OSY): Gr ades before dropping out of school Certificate of Indigence from the Barangay IV. ADDITIONAL INFORMATION Skills How/What do you know about SPES? Are you a former SPES? Previous office a ssignment Relative/Acquaintance in the DepEd Central Office What are your special circumst ance that we have to choose you over the others? If accepted, how do you plan to spend the money? Will you be able to complete the SPES? (April-May) Do you have a sibling/relative who is also applying? Do you have other activities during the summer? Describe the house you are livin g in

After accomplishing this form, save the file using your complete name and e-mail it to depedspes@gmail.com with your [Last Name, First Name] in the Subject Fiel d. Do not e-mail this form if your requirements are still incomplete. A Confirma tion Message containing your Interview Schedule and Control Number will be sent to your mobile number once the application form is processed. Take note of your Control Number and bring the required documents on the date of your interview. A PPLICANTS WITH INCOMPLETE DOCUMENTS WILL NOT BE INTERVIEWED. For DepEd Staff onl y. Do not write beyond this point. Date 3/1/13 Date of interview ______________________ Assigned Interviewer ______________________ Rating ______________________