pds_tsi.xlsx

7/23/2019 PDS_tsi.xlsx

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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION

2. S!#M$ C % # % P % & % ' % % % % % % % % % % % % % % % % % % % % % % % % % % %

*&!S' #M$ ' % $ % ! % $ % S % & %' % # % % % % % % % % % % % % % % % % % % % % % % % %

M&++$ #M$ & % % % % , % % % % % % % % % % % % % % % % % % % % % -. #M$ $'$S& (e.g. /r.0 Sr.)

1. +#'$ * &!'3 (445dd5yyyy) 625-656782 68. !$S&+$'&# #++!$SS

9. :0 ' 6;0 C!&S' !$<0 C#P#S0 '#!#C=. P#C$ * &!'3 C#P#S0 '#!#C

8. S$

:. C&>& S'#'S?&P C+$ 2-6=

6:. '$$P3$ . @7@77;76=28

6;. P$!M#$' #++!$SS

9. :0 ' 6;0 C!&S' !$<0 C#P#S0 '#!#C;. C&'&?$S3&P FILIPINO

7. 3$&,3' (4) 1.64M

6@. A$&,3' (kg) 68 Kg ?&P C+$ 2-6=

66. + '<P$ "!" 67. '$$P3$ . @7@77;76=28

,S&S &+ . 0060052500# 2@. $BM#& #++!$SS (if any)

6-. P#,B&&, &+ . 26. C$P3$ . (if any) @7@77;76=28

61. P3&3$#'3 . @:B@@@B@;6B-8:B@ 22. #,$C< $MP<$$ . 1-16::6

6=. SSS . 2-. '& 2@;B6--B-81B@@@

II. FAMILY BACKGROUND

21. SPS$S S!#M$ CPI$%LO 2=. #M$ * C3&+ (Arite full na4e and list all) +#'$ * &!'3 (445dd5yyyy)

*&!S' #M &O!LRMO /# /S$* &. C#P&' @65265677=

M&++$ # C%I'ON /#M$# &. C#P&' 6@ 5@; 5 677:

CCP#'& *A /#!$+ 9<$ &. C#P&' 6656856777

$MP<$!5S. #M$ S#+& $$C'!&C CMP#< /$&$! &. C#P&' @7 5 2: 5 2@@8

S&$SS #++!$SS 9S# 5 5

'$$P3$ . 5 5

(Continue on sepaate s!eet i" ne#essa$% 5 5

28. *#'3$!S S!#M$ &, 5 5

*&!S' #M$ ,?#

5 5M&++$ #M$ P#'#$ 5 5

2:. M'3$!S M#&+$ #M$ 5 5

S!#M$ S!&# 5 5

*&!S' #M$ P&#! 5 5

M&++$ #M$ #D& (Continue on sepaate s!eet i" ne#essa$%

III. EDUCATIONAL BACKGROUND

2;.

$>$

*ro4 'o

$$M$'#!< C#P#S A$S' C$'!# $$M$'#!< 67:7 ,!#+#'$ 6787 67:=

S$C+#!< +M&&C# SC3 3&,3 SC3 67:7 ,!#+#'$ 67:= 67:7

C$,$

&>$!S&'< * #,& S$$+ 67;- ,!#+#'$ 67:7 67;-

,!#+#'$ S'+&$S

P#MP#,# #,!&C'!# C$,$ 6777 ,!#+#'$ 677: 6777

P#MP#,# #,!&C'!# C$,$ +octor of $ducation 2@@; 2@66

(Continue on sepaate s!eet i" ne#essa$%

Page 6 of 1

62. [email protected]

#M$ * SC3(Arite in

full)

+$,!$$ C!S$(Arite in full)

3&,3$S' ,!#+$5$>$5

&'S $#!$+(if not graduated)

&CS&>$ +#'$S *#''$+#C$ SC3#!S3&P5

#C#+$M&C 3!S!$C$&>$+

Master in Professional

Studies

#cade4ic!eEuire4ents

#nnulled thers0 specify ___________

Single

Married

Aidowed

Separated

Male *e4ale

mailto:[email protected]

mailto:[email protected]



I&. CI&IL SER&ICE ELIGIBILITY

27.

!#'&, P#C$ * $#M&#'& 5 C*$!M$'

&C$S$ (if applicable)

M$!

$' :=.1@F @;5@65677: '#!#C C&'< @-21@@; @-B@2B7;


&. 'ORK EPERIENCE (In#)u*e pi+ate e,p)o$,ent. Stat "o, $ou #uent -o%

-@.

*ro4 'o

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

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(Continue on sepaate s!eet i" ne#essa$%CS *!M 262 (!eGised 2@@=)0 of 1

C#!$$! S$!>&C$5 !# 6@;@ (#!+5 #!) +$!SP$C&# #AS5 C$S5 CS$$

+#'$ *$#M&#'& 5C*$!M$'

+#'$ *!$$#S$

&CS&>$ +#'$S(445dd5yyyy)

PS&'& '&'$

(Arite in full)

+$P#!'M$' 5 #,$C< 5 **&C$ 5 CMP#<

(Arite in full)

M'3<S##!<

S##!< ,!#+$H S'$P

&C!$M$'(*or4at "@@B@")

S'#'S *#PP&'M$'

S$!>&C$

(<es 5



&I. &OLUNTARY 'ORK OR IN&OL&EMENT IN CI&IC / NON0GO&ERNMENT / PEOPLE / &OLUNTARY ORGANI1ATION/S

-6.PS&'& 5 #'!$ * A!9

*ro4 'o

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5


&II. TRAINING PROGRAMS (Stat "o, t!e ,ost e#ent tainin2.%

-2.

*ro4 'o

@; 5 21 566 @; 5 2= 566 68 +$P$+5&C' '$C3&C# S$!>&C$S

#'&# S$M&#! on CS'!C'& H &'$!P!$'#'& 62 5 2; 5@7 62 5-@ 5@7 21 +$P$+

6@ 5 @8 5@1 6@ 5 @7 5@1 -2 S$#M$BD$$

5 5 5 5

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5 5 5 5

5 5 5 5

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5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5

5 5 5 5


&III. OT3ER INFORMATION

--. SP$C&# S9&S 5 3&$SI -1. -=.

'<P&,

CMP'$! &'$!#'$


CS *!M 262 (!eGised 2@@=)0 Page - of 1

#M$ H #++!$SS * !,#&?#'&(Arite in full)

&CS&>$ +#'$S

(445dd5yyyy)M$! *

3!S

'&'$ * S$M&#!5C*$!$C$5A!9S3P5S3!' C!S$S (Aritein full)

&CS&>$ +#'$S * #''$+#C$

(445dd5yyyy)M$! *

3!S C+C'$+5 SPS!$+ <

(Arite in full)

!&$'#'& 5 !&$*&, on the #'&A&+$ !' * #'C3 :

S'3$#S' #S&# M&&S'!< of $+C#'& !,#&?#'&'$#C3$!S C#MP

B#C#+$M&C +&S'&C'&S 5 !$C,&'&I

(Arite in full)

#SSC&#'&5!,#&?#'&



-8. #re you related by consanguinity or affinity to any of the following I

a.

b.

-: a. 3aGe you eGer been for4ally chargedJ

b. 3aGe you eGer been guilty of any ad4inistratiGe offenseJ

-;.

-7.

1@. 3aGe you eGer been a candidate in a national or local election (except arangay election)J

16.

a. #re you a 4e4ber of any indigenous groupJ

&f <$S0 please specifyI KKKKKKKKKKKKKKKKKKKK

b. #re you differently abledJ


c. #re you a solo parentJ


12.

#M$ #++!$SS '$. .

M!. >&C'! . S#'S /! +$0 C#P#S0 '#!#C 9195699221

M!. #!'3! ,$!!$! +$0 C#P#S0 '#!#C 9219639919

9,+. M$!< '. >&#$># +$0 C#P#S0 '#!#C 9213653708

1-.

P3'

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CMM&'< '# C$!'&*&C#'$ .

C#P#S0 '#!#C

&SS$+ #'

@656252@62 @756252@62

&SS$+ (445dd5yyyy) +#'$ #CCMP&S3$+ !&,3' '3MM#!9

CS *!M 262 (!eGised 2@@=)0 Page 1 of 1

Aithin the third degree (for ational ,oGern4ent $4ployees)Iappointing authority0 reco44ending authority0 chief of office5bureau5depart4ent or person whohas i44ediate superGision oGer you in the ffice0 ureau or +epart4ent where you will beappointedJ

&f <$S0 giGe detailsI KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

Aithin the fourth degree (for ocal ,oGern4ent $4ployees)Iappointing authority or reco44ending authority where you will be appointedJ &f <$S0 giGe detailsI

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

&f <$S0 giGe detailsI KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK


3aGe you eGer been conGicted of any cri4e or Giolation of any law0 decree0 ordinance orregulation by any court or tribunalJ &f <$S0 giGe detailsI

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

3aGe you eGer been separated fro4 the serGice in any of the following 4odesI resignation0retire4ent0 dropped fro4 the rolls0 dis4issal0 ter4ination0 end of ter40 finished contract0 #A orphased out0 in the public or priGate sectorJ &f <$S0 giGe detailsI

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK


Pursuant toI (a) &ndigenous Peoples #ct (!# ;-:6)L (b) Magna Carta for +isabled Persons (!#:2::)L and (c) Solo Parents Aelfare #ct of 2@@@ (!# ;7:2)0 please answer the following ite4sI

!$*$!$C$S (Person not related by consanguinity or affinity to applicant 5 appointee)

& declare under oath that this Personal +ata Sheet has been acco4plished by 4e0 and is a true0 correct andco4plete state4ent pursuant to the proGisions of pertinent laws0 rules and regulations of the !epublic of thePhilippines.

& also authorie the agency head 5 authoried representatiGe to Gerify 5 Galidate the contents stated herein. & trustthat this infor4ation shall re4ain confidential.

S&,#'!$ (Sig iside *e +o,)

ID picture taken withinthe last 6 months3.5 cm. !.5 cm"passport si#e$

%omputer &enerate'or (ero( copy o) picture

is not accepta*le

<$S

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<$S

<$S

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