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    Application Form: Professional Regulation Commission

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    George Tilap
    - John Cesar Suelto applied to take the November 2022 Civil Engineer licensure examination in Davao. - He graduated from Jose Maria College in Davao City with a BS in Civil Engineering in December 2021. - In his previous exam attempts, he failed the November 2022 Civil Engineer exam with a score of 60.15 but has not yet passed. - He paid 900 pesos and was issued a Notice of Admission to sit for the upcoming November 2022 Civil Engineer licensure examination.

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    Application Form: Professional Regulation Commission

    Uploaded by

    George Tilap
    7 views1 page
    - John Cesar Suelto applied to take the November 2022 Civil Engineer licensure examination in Davao. - He graduated from Jose Maria College in Davao City with a BS in Civil Engineering in December 2021. - In his previous exam attempts, he failed the November 2022 Civil Engineer exam with a score of 60.15 but has not yet passed. - He paid 900 pesos and was issued a Notice of Admission to sit for the upcoming November 2022 Civil Engineer licensure examination.

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    - John Cesar Suelto applied to take the November 2022 Civil Engineer licensure examination in Davao. - He graduated from Jose Maria College in Davao City with a BS in Civil Engineering in December 2021. - In his previous exam attempts, he failed the November 2022 Civil Engineer exam with a score of 60.15 but has not yet passed. - He paid 900 pesos and was issued a Notice of Admission to sit for the upcoming November 2022 Civil Engineer licensure examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views1 page

    Application Form: Professional Regulation Commission

    Uploaded by

    George Tilap
    - John Cesar Suelto applied to take the November 2022 Civil Engineer licensure examination in Davao. - He graduated from Jose Maria College in Davao City with a BS in Civil Engineering in December 2021. - In his previous exam attempts, he failed the November 2022 Civil Engineer exam with a score of 60.15 but has not yet passed. - He paid 900 pesos and was issued a Notice of Admission to sit for the upcoming November 2022 Civil Engineer licensure examination.

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    APPOINTMENT DATE: Sep 01, 2022 (04:00 PM TO 05:00 PM) - PRC Davao

    Professional Regulation Commission

    APPLICATION FORM

    NOT FOR SALE (REPRODUCTION IS ALLOWED)


    REFERENCE NO: EXNGDO5OYG5T
    Application No.
    OR: E2022-08-02499100 | AMOUNT: PHP 900.00
    031897
    X First Timer
    Repeater Name of Examination CIVIL ENGINEER
    _________________________________
    Conditioned Date of Examination NOVEMBER 19 - 20, 2022
    _________________________________
    Absent
    Place of Examination Davao
    _________________________________
    ________________
    08/30/2022
    Date(mm/dd/yy)
    NOTICE: All supporting documents shall become part of the records of the Commission. All applications must be filed
    PERSONALLY by the applicant.

    PART I-PERSONAL INFORMATION


    SUR NAME GIVEN NAME/S MIDDLE NAME
    SUELTO JOHN CESAR SATORRE
    Maiden Surname (for married female only)

    Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
    217 PISCES ST. GSIS HEIGHTS MATINA 74-A MATINA CROSSING DAVAO CITY, DAVAO DEL SUR
    Gender Citizenship Contact numbers (Landline & Mobile) E-mail Address
    X Male Female X Filipino Others______ 09384828882 cesarsuelto29@gmail.com
    Civil Status Date of Birth(mm/dd/yy) Place of Birth (City/Town,Prov) RURBAN Code(Town/City,Prov)
    X Single Married Widow/er 04/29/1999 DAVAO CITY, DAVAO DEL SUR 112402
    Spouse’s name & Citizenship Father’s Name & Citizenship Mother’s Name & Citizenship
    NELSON PREXY F. SUELTO / FILIPINO ERLINDA S. SUELTO / FILIPINO
    HAVE YOU EVER BEEN CHARGED AND CONVICTED BY FINAL JUDGEMENT BY ANY COURT OF JUSTICE/MILITARY TRIBUNAL OR
    ADMINISTRATIVE BODY? X No Yes (If yes, attach hereto a copy of the decision)
    PART II – EDUCATIONAL INFORMATION
    Name of School Address/Location of School PRC School code
    JOSE MARIA COLLEGE CATITIPAN, DAVAO CITY, DAVAO DEL SUR 2139
    Degree/Course Obtained PRC COURSE Code Date Graduated (mm/dd/yy) PRC Board Code
    BS IN CIVIL ENGINEERING 3044 12/21/2021 0600
    Date Graduated PRC SCHOOL
    Other Higher Educational Attainment Name of School Address/Location of School CODE
    (mm/dd/yy)

    PART III – PREVIOUS PRC LICENSURE EXAMINATION/S TAKEN (Last Three Exams)
    Place of Date Taken Result of Examination (pls check)
    Name of Examination Rating Exam No. Verified by
    Examination (mm/yy) Passed Failed Cond.
    CIVIL ENGINEER - 04/2023 70.00 X
    CIVIL ENGINEER - 11/2022 60.15 X

    Review School/Center: Self-Review School-Based Review Others (specify name) __________________________


    STATUS CODES (refer at the back) 1.) Examination Type (EXcode) 2.) Number of Times Taken 2

    I HEREBY CERTIFY that the information and/or ACTION TAKEN BY THE APPLICATION PROCESSOR
    statements in this application including the supporting ISSUANCE of the FOLOWING FORMS
    documents submitted in support thereof are all true and
    correct to my own knowledge, and that I am fully aware that NOTICE OF ADMISSION PERMANENT EXAMINATION &
    (NOA) REGISTRATION RECORD CARD (PERRC)
    any false information or statement in this application or in its
    attachments shall render me liable for criminal prosecution REMARKS ______________________________________________
    and/or administrative sanction. ______________________________________________________________________________

    PROCESSOR_____________________________ Date ___________


    RIGHT THUMBMARK _______________________ ____________________________________________________________
    Signature of Applicant ACTION TAKEN BY LEGAL OFFICER (if applicable)
    _______________________ REMARKS ______________________________________________
    Date Accomplished ______________________________________________________________________________

    LEGAL OFFICER __________________________ Date ___________


    Subscribed and sworn to before me this __________day of ____________________________________________________________
    _________20____at__________. Affiant applicant exhibited ACTION TAKEN BY THE BOARD
    to me his / her Community Tax Certificate No. APPROVED DISAPPROVED CONDITIONAL
    P9088354A
    ________________________issued atDFA GENERAL SANTOS
    _______________
    REMARKS ______________________________________________
    on _____________.
    10/10/2018 ______________________________________________________________________________
    DOCUMENTARY STAMP

    CHAIRMAN/ MEMBER ______________________ Date __________


    ____________________________________________________________
    ACTION TAKEN BY THE CASHIER
    _______________________________
    PRC ADMINISTERING OFFICER AMOUNT PAID ____________
    900.00 OFFICIAL RECEIPT NO.E2022-08-02499100
    _____________
    Paymaya - Gcash Payment
    CASHIER _________________________________ 08/30/2022
    Date __________
    ____________________________________________________________
    ACTION TAKEN BY THE ISSUING OFFICER
    Administration of Oath Is Free REMARKS _______________________________________________
    (Office Order No. 2009-377 & 2009-379 ______________________________________________________________________________
    both dated September 3, 2009)
    ISSUING OFFICER ________________________ Date __________

    IMPORTANT: FAILURE TO SUBMIT THIS APPLICATION FORM WITH THE REQUIRED DOCUMENTS SHALL MEAN APP-01
    NON-INCLUSION IN THE LIST OF EXAMINEES IN THE ROOM ASSIGNMENT AND FORFEITURE OF EXAMINATION FEES Rev. 00
    February 25, 2015
    Page 1 of 1

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