CS FORM *** (Revised ****)

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. SURNAME ENARIO

FIRST NAME VICKY

MIDDLE NAME PENONES 3. NAME EXTENSION (e.g. Jr., Sr.) 4. DATE OF BIRTH (mm/dd/yyyy) 12 / 09 / 1983 16. RESIDENTIAL ADDRESS Sitio Cabaasan, Sambagon, PINAMUNGAHAN, CEBU 5. PLACE OF BIRTH

Patin-ay, Provincial Hospital,

Agusan Del Sur

6. SEX MALE FEMALE

7. CIVIL STATUS

Single Widowed

Married Separated

Annuled Others, specify

ZIP CODE 6039

17. TELEPHONE NO.

18. PERMANENT ADDRESS Cabaasan, Sambagon,, PINAMUNGAHAN, CEBU 8. CITIZENDSHIP FILIPINO

9. HEIGHT (m) 4"11"

10. WEIGHT (kg) 52 ZIP CODE 6039

11. BLOOD TYPE O+ 19. TELEPHONE NO.

12. GSIS ID NO. 20. EMAIL ADDRESS (if any) ac47ig@r.postjobfree.com 13. PAGIBIG ID NO. 21. CELLPHONE NO. (if any) 093********-**. PHILHEALTH NO. 22. AGENCY EMPLOYEE NO. 160*********-**. SSS NO. 092*******-**. TIN 1464840

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME Enario 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) FIRST NAME Ronaldo JEREMY MICAH P. ENARIO 09 / 21 / 2015 MIDDLE NAME Nieves

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME

FIRST NAME

MIDDLE NAME

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Penones

FIRST NAME Ruth

MIDDLE NAME Coter

III. EDUCATIONAL BACKGROUND

NAME 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 SCHOLARSHIP/ ACADEMIC

HONORS RECEIVED

LEVEL

From To

ELEMENTARY

Maglambing Elementary

School

1996

1991-06-

07

1996-03-

24

SECONDARY SSPSC - Tagbina Campus

1996-06-

20

1998-03-

28

Alternative Learning System

Tibungco Davao District

2007

2006-06-

03

2007-04-

21

VOCATIONAL/ TRADE

COURSE

COLLEGE

University of Mindanao -

Tagum Campus

Bachelor of

Secondary Education

2010-06-

17

2013-04-

20

Unique Applicant Number

T15252260

ENARIO, VICKY PENONES - T15252260 CS FORM 212 (Revised 2005), Page 1 of 4 III. EDUCATIONAL BACKGROUND

NAME 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 SCHOLARSHIP/ ACADEMIC

HONORS RECEIVED

LEVEL

From To

University of the Visayas -

Mandaue Campus

Bachelor of

Secondary Education

2015

2013-06-

15

2015-03-

20

GRADUATE STUDIES

IV. CIVIL SERVICE ELIGIBILITY

29.

CAREER SERVICE/ RA 1080 (BOARD/ BAR)

UNDER SPECIAL LAWS/ CES/ CSEE

RATING

DATE OF

EXAMINATION /

CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

LICENSE (if applicable)

NUMBER

DATE OF

RELEASE

LET (LICENSURE EXAMINATION FOR

TEACHER)

76.60 03 / 20 / 2016 Cebu 1464840 05/19/2016

V. WORK EXPERIENCE

30. 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

GOV'T SERVICE

(Yes / No)

From To

201*-**-**-**/31/2017 Senior High School Teacher Maco Institute of Technology, Inc. 8000 0 - 0 Full probi No VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 31.

NAME & ADDRESS OF ORGANIZATION

(Write in full)

INCLUSIVE DATES

(mm/dd/yyyy) NUMBER OF

HOURS

POSITION / NATURE OF WORK

From To

Values Restoration Program Mabini Compostela Valley Province 06 / 20 / 1998 10 / 30 / 2017 Lecturer 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

CONDUCTED/ SPONSORED BY

(Write in full)

From To

Semi-annual Planning and assessment 08 / 17 / 2017 08 / 18 / 2017 16 Provincial Governor's Office Visual Graphic Design 06 / 06 / 2017 08 / 28 / 2017 240 Tesda Pastor's and Leader's Conference 02 / 06 / 2017 02 / 09 / 2017 20 King's Chapel Sultan Kudarat Diploma of Biblical Studies 10 / 15 / 2002 05 / 29 / 2004 International School of Ministry VIII. OTHER INFORMATION

33.

SPECIAL SKILLS / HOBBIES:

34. NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)

35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION

(Write in full)

Computer savvy, Web and Logo Design,

Adobe Photoshop, Corel Draw, Sketch up

Certificate of Recognition - Resource Speaker At Mabini Technical Training Center

King's Chapel International Ministry Pastor

My Hobby is in Musical instruments like guitar

and Playing Keyboard

Certification of Appearance - National Achievement Test Proctor At Attorney Orlando S. Ronaldo National High School Maco Compostela Valley Province

Loves to travel and adventures

ENARIO, VICKY PENONES - T15252260 CS FORM 212 (Revised 2005), Page 2 of 4 36. Are you related by consanguinity or affinity to any of the following : a. 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 details:

b. Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed? YES NO

If YES, give details:

37. a. Have you ever been formally charged?

YES NO

If YES, give details:

b. Have you ever been guilty of any administrative offense? YES NO

If YES, give details:

38. 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 details:

39. 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 details:

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

If YES, give details:

41. 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: a. Are you a member of any indigenous group?

YES NO

If YES, please

specify:

b. Are you differently abled?

YES NO

If YES, please

specify:

c. Are you a solo parent?

YES NO

If YES, please

specify:

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO.

PHOTO

X

Mrs. ANALIZA BAYA - Elementary Teacher Mangoto Pinamungajan Cebu 094******** Hon. Brgy. Captain Pableo Larano SAMBAGON PINAMUNGAJAN CEBU 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.

CCI20162780376

COMMUNITY TAX CERTIFICATE NO.

Sambagon Pinamungajan Cebu

ISSUED AT

2018-01-03

ISSUED ON (mm/dd/yyyy)

SIGNATURE (Sign inside the box)

10 / 01 / 2018

DATE ACCOMPLISHED

RIGHT THUMBMARK

ENARIO, VICKY PENONES - T15252260 CS FORM 212 (Revised 2005), Page 3 of 4 ENARIO, VICKY PENONES - T15252260 CS FORM 212 (Revised 2005), Page 4 of 4

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