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Statement of Relatives Form - BIR

Karen Claudine M. Linda has applied for the position of Attorney II at the Bureau of Internal Revenue. She lists her preferred places of assignment but acknowledges she may be assigned anywhere needed. She affirms she has no relatives currently working at the BIR who could present a conflict of interest based on their role. If such a relationship was later discovered, she agrees her appointment could be revoked. She also consents to accept any work assignment given by the BIR if selected.

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Mariel Reyes
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628 views1 page

Statement of Relatives Form - BIR

Karen Claudine M. Linda has applied for the position of Attorney II at the Bureau of Internal Revenue. She lists her preferred places of assignment but acknowledges she may be assigned anywhere needed. She affirms she has no relatives currently working at the BIR who could present a conflict of interest based on their role. If such a relationship was later discovered, she agrees her appointment could be revoked. She also consents to accept any work assignment given by the BIR if selected.

Uploaded by

Mariel Reyes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Finance
BUREAU OF INTERNAL REVENUE
Quezon City

27 December 2022
Date

Name of Applicant: Karen Claudine M. Linda


Applied Position: Attorney II

Preferred Place of Assignment: 1.)


2.)
3.)
I have been well informed and briefed regarding the job vacancies in the Bureau and the position I have written
on this form is what I am applying for.

Relative(s) in the BIR ☐With Relative/s ☐


/ Without Relative/s

If with relative, please write the name and check the appropriate box & encircle the relationship with the
applicant

1 ________________________ ☐ Father/Mother ☐ Uncle/Aunt (brother/sister of mother/father or brother-in-


2 ________________________ ☐Brother/Sister law/sister-in-law of mother/father)
3 ________________________ ☐ Husband/Wife ☐ First Cousin
4 ________________________
☐ Son/ Daughter ☐ In-law (Father/Mother/Brother/Sister)
I declare under the penalties of perjury that the above answers are made in good faith and to the best of
my knowledge and belief are true and correct. That if it is later found that I have a relative in the BIR under the
following circumstances (Sec.6 of Rule XVIII of Omnibus Rules Implementing Book V of Executive Order No. 292 and
Other Pertinent Civil Service Laws):

1. Head of Agency
2. Appointing Authority
3. Recommending Official
4. Immediate Supervisor/Superior

I am willing to have my appointment revoked because my employment is a violation of existing Civil Service Law and
Rules.

Signature of Applicant
--------------------------------------------------------------------------------------------------------------------------------------------------------
WAIVER ON PLACE OF WORK ASSIGNMENT
In the event that I am selected by the Board and I have accepted the job offered by the Bureau of Internal
Revenue, I hereby agree to be assigned to any BIR office to meet the urgent needs of the Bureau.

I shall comply with all the rules and regulations, and policies issued by the Bureau, as well as with all
orders and instructions of my duly designated superiors and other authorized officers.

KAREN CLAUDINE M. LINDA


Name and Signature of Applicant

Date: 12/27/2022

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