pds_josie

8/11/2019 PDS_josie

1/16

CS FORM 212 (Revised 2005)

2. SURNAME S A L A S

FIRST NAME J O C E L Y N

MIDDLE NAME T A M O N D O N G

4.

5. PLACE OF BIRTH

6. SEX

CIVIL STATUS

Married 17. TELEPHONE NO.

8. CITIZENSHIP

9. HEIGHT (m)

10. WEIGHT (kg)

11. BLOOD TYPE

12. GSIS ID NO.

13. PAG-IBIG ID NO.

14. PHILHEALTH NO.

15. SSS NO.

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

26.

27. MOTHER'S MAIDEN NAME

DATE OF BIRTH (mm/dd/yyyy) 16. RESIDENTIAL ADDRESS

O'DONNELL, CAPAS TARLAC

Male Female

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes with " P " and use separate sheet if necessary. 1. CS ID No. (to be f

I. PERSONAL INFORMATION

3. NAME EXTENSION (e.g. Jr., Sr.)

PANDO, CONCEPCION, TARLAFILIPINO

1.35 M

50 KLS. ZIP CODE 2316

7. Single Widowed ZIP CODE 2315

Separated

Annulled Others, Specify ____ 18. PERMANENT ADDRESS

21. CELLPHONE NO. (if any) 09214676967

19 - 000322801 - 4 22. AGENCY EMPLOYEE NO. 4329976

"O" 19. TELEPHONE NO. N/A

63050702245 20. E-MAIL ADDRESS (if any)

N/A

23. TIN 173 - 641 - 742

II. FAMILY BACKGROUND

N/A DATE OF BIRT

MIDDLE NAME ESPINOSA

(Continue on separate sheet if necessary)

FATHER'S SURNAME SALAS

ELEMENTARY CORAL CAMBING ELEM. SCHOOL 1975 1969 1975

FIRST NAME CLARITA

MIDDLE NAME TAAL (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

28.

LEVELNAME OF SCHOOL

(Write in full)

DEGREE COURSE

(Write in full)

YEAR

GRADUATED

(if graduated)

HIGHEST GRADE/

LEVEL/

UNITS EARNED

(if not graduated)

INCLUSIVE DATES OF

ATTENDANCE

GRADUATE STUDIESHARVADIAN COLLEGES

MASTER OF ARTS

IN EDUCATION36 UNITS 1999 2003

1987 1989

COLLEGE TARLAC COLLEGE OF

TECHNOLOGY

B.S. IN HOME

TECHNOLOGGY1983 1979


1983

VOCATIONAL /

TRADE COURSE

TARLAC COLLEGE OF

TECHNOLOGYB.E.Ed.

SECONDARY TARLAC HIGH SCHOOL 1979 1975 1979

1989

To

S

From

SURNAME TAMONDONG

FIRST NAME PACIFICO

8/11/2019 PDS_josie

2/16

8/11/2019 PDS_josie

3/16

illed up by CSC)

C

(mm/dd/yyyy)

HOLARSHIP/

ACADEMIC

HONORS

RECEIVED

8/11/2019 PDS_josie

4/16

Page 1 of 4

8/11/2019 PDS_josie

5/16

29.

NUMBER

79.36% 068634

30.

PBET DEC. 10, 1989 TARLAC, TARLAC

IV. CIVIL SERVICE ELIGIBILITY

CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER

SPECIAL LAWS/ CES/ CSEERATING

DATE OF

EXAMINATION /

CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

LICENSE (if ap


V. WORK EXPERIENCE (Include private employment. Start from your current work)

INCLUSIVE DATES

(mm/dd/yyyy) POSITION TITLE

(Write in full)

DEPARTMENT / AGENCY / OFFICE /

COMPANY

(Write in full)

MONTHLY

SALARY

SALARY GRADE

& STEP

INCREMENT

(Format "00-0")

STATUS OF

APPOINTMENT

From To


8/11/2019 PDS_josie

6/16

CS FORM 212 (Revised 200

8/11/2019 PDS_josie

7/16

DATE OF

RELEASE

JUNE 4,

1990

plicable)

GOV'T

SERVICE

(Yes / No)

8/11/2019 PDS_josie

8/16

), Page 2 of 4

8/11/2019 PDS_josie

9/16

/ / / /

33. SPECIAL SKILLS / HOBBIES: 34. 35.

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGA

31. NAME & ADDRESS OF ORGANIZATION

(Write in full)

INCLUSIVE DATES

(mm/dd/yyyy) NUMBER OF

HOURSPO

From To

To

DIVISION EPP SEMINAR WORKSHOP ON EPP 08 03 11 08 05 11


VII. TRAINING PROGRAMS (Start from the most recent training.)

32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES

(Write in full)

INCLUSIVE DATES OF ATTENDANCE

(mm/dd/yyyy) NUMBER OF

HOURS

CO

From

COOKING, CROCHETING


VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)


8/11/2019 PDS_josie

10/16

CS F

8/11/2019 PDS_josie

11/16

IZATION/S

SITION / NATURE OF WORK

NDUCTED/ SPONSORED BY

(Write in full)

MEMBERSHIP IN

SSOCIATION/ORGANIZATION

(Write in full)

8/11/2019 PDS_josie

12/16

RM 212 (Revised 2005), Page 3 of 4

8/11/2019 PDS_josie

13/16

36.

a.

b.

37

38.

39.

40.

41.

a.

b.

c.

42.

NAME ADDRESS

O'DONNELL CAPAS, TARLAC

PANDO, CONCEPCION, TARLAC

CONCEPCION, TARLAC

05172501

COMMUNITY TAX CERTIFICATE NO.

CAPAS, TARLAC

ISSUED AT

01 - 13 - 2012

ISSUED ON (mm/dd/yyyy)

Are you related by consanguinity or affinity to any of the following :

Within the third degree (for National Government Employees): appointing

authority, recommending authority, chief of office/bureau/department or person who has immediate supervision

over you in the Office, Bureau or Department where you will be appointed?

YES NO

If YES, give detai

_____________

_____________

_____________Within the fourth degree (for Local Government Employees): appointing

authority or recommending authority where you will be appointed? YES NO

If YES, give detai

_____________

_____________

_____________a. Have you ever been formally charged?

YES NO

If YES, give detai

_____________

_____________b. Have you ever been guilty of any administrative offense?

YES NO

If YES, give detai

_____________

_____________Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court

or tribunal?

YES NO

If YES, give detai

_____________

_____________

Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped

from the rolls, dismissal, termination, end of term, finished contract, AWOL or phased out, in the public or

private sector?

YES NO

If YES, give detai

_____________

_____________

Have you ever been a candidate in a national or local election (except Barangay election)?YES NO

If YES, give detai_____________

_____________Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c)

Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:

Are you a member of any indigenous group?YES NO

If YES, please spAre you differently abled?

YES NO

If YES, please sp

ALLADIN M. QUIAMBAO

Are you a solo parent?YES NO

If YES, please sp

REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

TEL. NO.

VICTOR O. SANTOS JR.

HERMIE E. NOBLES

DATE ACCOMPLISHED

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and

complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the

Philippines.

I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust

that this information shall remain confidential.

SIGNATURE (Sign inside the box)

8/11/2019 PDS_josie

14/16

CS

8/11/2019 PDS_josie

15/16

PHOTO

RIGHT THUMBMARK

ls:

_______________________

_______________________

_______________________

ls:

_______________________

_______________________

_______________________

ls:

__________________

__________________

ls:

__________________

__________________

ls:

__________________

__________________

ls:

__________________

__________________

ls:__________________

__________________

ecify: ____________________

ecify: ____________________

ecify: ____________________

ID picture taken withinthe last 6 months3.5 cm. X 4.5 cm(passport size)

Computer generatedor xerox copy of picture

is not acceptable

ID picture taken withinthe last 6 months3.5 cm. X 4.5 cm(passport size)

Computer generatedor xerox copy of picture

is not acceptable

8/11/2019 PDS_josie

16/16

FORM 212 (Revised 2005), Page 4 of 4

pds_josie

Documents