IPCR
IPCR
IPCR
I, , , In employment status, with a monthly salary of Php. and Salary Grade Level of SG
from commits to deliver and agree to be rated on the attainment of the following targets in accordance with the indicate measures for the period of to
Name of Employee
Reviewed by: Date: Noted by: Date: Approve by: Date: Ratinng Scale:
5 - Outstanding
4 - Very Satisfactory
3 - Satisfactory
HON. JUNARD "AHONG" Q. CHAN 2 - Unsatisfactory
Immediate Supervisor Department Head City Mayor 1 - Poor
RATING
SUCCESS INDICATORS
MFO/FAP ACTUAL ACCOMPLISHMENTS Remarks
(TARGETS + MEASURES)
QN QL T A
Core Functions
DIVISION/SECTION
1∙ 0
2∙ 0
3∙ 0
4∙ 0
5∙ 0
6∙ 0
Commitment: IPCR submitted to HRMDO on the ____________of IPCR submitted to HRMDO on the __________________of
IPCR submitted to HRMDO for initaial review __________________ ____________ ____________________ ____________
SUPPORT FUNCTIONS(10%)
Attendance to flag raising ceremonies 100% attendance to flag rasing ceremonies 90% attendance to flag ceremonies 3
Attendance to City respondent officail activities 100% attendance officail activities 100% attendance to city inconsired officail activities 4
Discussed With: Date: Assessed by: Date: Reviewed by: Date: Reviewed by: Date:
(Name) (Name)
For the Month of_ 2023 For the Month of_
A.M. P.M. A.M.
Official hours for Reg. Day __________ Official hours for Reg. Day __________
Arrival and Departure Week. Day _________ Arrival and Departure Week. Day _________
A.M. P.M. OVERTIME A.M. P.M. OVERTIME
DAYS DAYS
Arrival Depart Arrival Depart Hours MIN. Arrival Depart Arrival Depart Hours
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
TOTAL TOTAL
I CERTIFY on my honor that the above is a true and correct report I CERTIFY on my honor that the above is a true and correct report
of the hours of worked performed record of which was made daily of the hours of worked performed record of which was made daily
at the time of arrival at and departure from the office. at the time of arrival at and departure from the office.
Verified as to the presence office hours Verified as to the presence office hours
2023
P.M.
. Day __________
ek. Day _________
OVERTIME
MIN.
GE
SWORN STATEMENT OF ASSET, LIABILITIES AND NET WORTH
As Of
( Required by R.A. 6713 )
Note: Husband and Wife are both public officials and employees may fil the required statements jiontly or separately
Jiont Filing Separate Filing Not Applicable
DECLARANT: POSITION:
( Family Name ) ( First Name ) ( M.I. ) AGENCY/OFFICE:
ADDRESS: OFFICE ADDRESS:
SPOUSE: POSITION:
( Family Name ) ( First Name ) ( M.I. ) AGENCY/OFFICE:
OFFICE ADDRESS:
UNMARIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
a. Real Properties*
Subtotal:
b. Personal
Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT
Subtotal:
TOTAL ASSETS ( a + b ). ___________________________
2. LIABILITIES*
Page 1 of ____
* Additional sheet/s may be used, if necessary.
NAME OF ENTITY/BUSINESS ADDRESS BUSINESS ADDRESS NATURE OF BUSINESS INTERIST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR CONNECTION
I hereby certify that these are true and correct statemants of my assets, liabilities, net worth, business interest and financial connections,
including those of my spouse and unmarried children below eighteen (18) years of age living in my household, and that best of my knowledge, the
above - enumerated are names of my relatives in the government within the fourth civil degree of consanguinity or affinity.
I hereby authorize the Ombudsman or his/her duly authorized representative to obtain and secure from all appropriate government agencies,
including the Bureau of Internal Revenue such documents that may show my assets, liabilities, net worth, businees interest and financial connectios, to
include those of my spouse and unmarried children below 18 years of age living with me in my household covering previous years to include the year I
first assumed office in government.
Date:
ID No: ID No:
SUBSCRIBE AND SWORN to before me this _____ day of ______ affiant exhibiting to me the above - stated goverment issued identification card.
Page 2 of _____
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