APPOINTMENT DATE: Feb 27, 2025 (09:00 AM TO 10:00 AM) - Ayala Malls - Manila Bay
Professional Regulation Commission
APPLICATION FORM
NOT FOR SALE (REPRODUCTION IS ALLOWED)
REFERENCE NO: EXXXMDSM021J
OR: E2025-02-11095480 | AMOUNT: PHP 600.00
Application No.
018517
X First Timer
Repeater
Conditioned
Absent
02/26/2025
________________
Name of Examination
ELECTRONICS TECHNICIAN
_________________________________
Date of Examination
APRIL 4, 2025
_________________________________
Place of Examination
Manila
_________________________________
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
FAJARITO
MEANCK
Maiden Surname (for married female only)
MIDDLE NAME
ARAGON
Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
8410 GOMBURZA EXT. STO.NIñO PARANAQUE, METRO MANILA
Gender
Citizenship
Contact numbers (Landline & Mobile)
X Male
X Filipino
Female
Others______
09938738060
E-mail Address
meanckpogi@gmail.com
Civil Status
X Single
RURBAN Code(Town/City,Prov)
047604
Married
Spouse’s name & Citizenship
Widow/er
Date of Birth(mm/dd/yy)
05/29/2000
Place of Birth (City/Town,Prov)
PARANAQUE, METRO MANILA
Father’s Name & Citizenship
JEONY L. FAJARITO / FILIPINO
Mother’s Name & Citizenship
MARY GRACE A. FAJARITO / 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
UNIVERSAL COLLEGES OF PARAÑAQUE
SUCAT, PARANAQUE, MM
2168
Degree/Course Obtained
PRC COURSE Code
Date Graduated (mm/dd/yy)
PRC Board Code
BACHELOR OF SCIENCE IN ELECTRONICS AND COMMUNICATIONS
3049 ENGINEERING
08/03/2024
1203
PRC SCHOOL
Date Graduated
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)
Name of Examination
Place of
Examination
Date Taken
(mm/yy)
Rating
Review School/Center:
Self-Review
School-Based Review
STATUS CODES (refer at the back)
1.) Examination Type (EXcode)
I HEREBY CERTIFY that the information and/or
statements in this application including the supporting
documents submitted in support thereof are all true and
correct to my own knowledge, and that I am fully aware that
any false information or statement in this application or in its
attachments shall render me liable for criminal prosecution
and/or administrative sanction.
Result of Examination (pls check)
Passed
Failed
Cond.
Exam No.
Verified by
Others (specify name) __________________________
2.) Number of Times Taken 0
ACTION TAKEN BY THE APPLICATION PROCESSOR
ISSUANCE of the FOLOWING FORMS
NOTICE OF ADMISSION
PERMANENT EXAMINATION &
(NOA)
REGISTRATION RECORD CARD (PERRC)
REMARKS ______________________________________________
______________________________________________________________________________
PROCESSOR_____________________________ Date ___________
RIGHT THUMBMARK
_______________________
Signature of Applicant
_______________________
Date Accomplished
____________________________________________________________
ACTION TAKEN BY LEGAL OFFICER (if applicable)
REMARKS ______________________________________________
______________________________________________________________________________
LEGAL OFFICER __________________________ Date ___________
DOCUMENTARY STAMP
Subscribed and sworn to before me this __________day of
_________20____at__________. Affiant applicant exhibited
to me his / her Community Tax Certificate No.
N26-18-037388
LTO
________________________issued
at _______________
05/29/2023
on _____________.
____________________________________________________________
ACTION TAKEN BY THE BOARD
APPROVED
DISAPPROVED
CONDITIONAL
REMARKS ______________________________________________
______________________________________________________________________________
CHAIRMAN/ MEMBER ______________________ Date __________
____________________________________________________________
_______________________________
PRC ADMINISTERING OFFICER
ACTION TAKEN BY THE CASHIER
AMOUNT PAID ____________
OFFICIAL RECEIPT NO.E2025-02-11095480
_____________
600.00
Paymaya - Gcash Payment
02/26/2025
CASHIER _________________________________
Date __________
____________________________________________________________
Administration of Oath Is Free
(Office Order No. 2009-377 & 2009-379
both dated September 3, 2009)
ACTION TAKEN BY THE ISSUING OFFICER
REMARKS _______________________________________________
______________________________________________________________________________
ISSUING OFFICER ________________________ Date __________
IMPORTANT: FAILURE TO SUBMIT THIS APPLICATION FORM WITH THE REQUIRED DOCUMENTS SHALL MEAN
NON-INCLUSION IN THE LIST OF EXAMINEES IN THE ROOM ASSIGNMENT AND FORFEITURE OF EXAMINATION FEES
APP-01
Rev. 00
February 25, 2015
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