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

INCLUSIVE DATES

31. NAME & ADDRESS OF ORGANIZATION NUMBER OF

POSITION / NATURE OF WORK

(Write in full) HOURS

(mm/dd/yyyy)

From To

PRSDRSTDEA 11/02/2004

CPSTAERA 2004 PRESENT

(Continue on separate sheet if necessary)

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

INCLUSIVE DATES OF

ATTENDANCE

32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY

(Write in full) HOURS (Write in full)

(mm/dd/yyyy)

From To

SCHOOL-BASED MANAGEMENT, CFSS AND

9/20/2000 9/21/2010 16 DIVISION

ALTERNATIVE DELIVERY MODE

23RD DISTRICT CAMPORAL & CAMPORAL 12/10/2007 10/13/2007 16 DIVISION

20TH BSP-GSP JOINT DISTRICT CAMPORAL &

10/15/2004 10/16/2014 16 DISTRICT

ENCAMPMENT

RE-ECHO SEMINAR WORKSHOP IN ENGLISH AND

9/13/2004 7 DISTRICT

MATHEMATICS

DIV. LEVEL TRAINING OF TRAINERS ON THE

INTEGRATION OF BASIC MESSAGES/CONCEPTS ON 02/08/2004 6 DISTRICT

SALT IODIZATION

BASIC COMPUTER AND INTERNET LITERACY 10/25/2011 6 DISTRICT

LEVEL 3 DIVISION ROLL OUT ON EBEIS 8/23/2011 6 DIVISION

1ST DISTRICT LEVEL LEADERSHIP TRAINING OF SPG 5/23/2011 6 DISTRICT

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION MEMBERSHIP IN

ASSOCIATION/ORGANIZATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

33. SPECIAL SKILLS / HOBBIES: 34. 35.

(Write in full)

(Write in

full)

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4

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

a. Within the third degree (for National Government Employees): YES NO

appointing authority, recommending authority, chief of If YES, give details:

office/bureau/department or person who has immediate supervision over you

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

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where If YES, give details:

you will be appointed?

37 a. Have you ever been formally charged? YES NO

If YES, give details:

YES NO

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

If YES, give details:

38. Have you ever been convicted of any crime or violation of any law, decree, YES NO

ordinance or regulation by any court or tribunal? If YES, give details:

39. Have you ever been separated from the service in any of the following modes: YES NO

resignation, retirement, dropped from the rolls, dismissal, termination, end of

term, finished contract, AWOL or phased out, in the public or private sector? If YES, give details:

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

Barangay election)?

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.

TERESITA SULIGUIN POBLACION, PRES. ROXAS NONE

ID picture taken within

the last 6 months

GLORIA IRIG KIDAPAWAN CITY NONE 3.5 cm. X 4.5 cm

(passport size)

ALFREDO LUZON LABU-O, PRES. ROXAS NONE

Computer generated

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a or xerox copy of picture

true, correct and complete statement pursuant to the provisions of pertinent laws, rules and is not acceptable

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. PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4

IV. CIVIL SERVICE ELIGIBILITY

LICENSE (if applicable)

29. DATE OF

CAREER SERVICE/ RA 1080 (BOARD/ BAR) DATE OF

RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT

UNDER SPECIAL LAWS/ CES/ CSEE RELEAS

NUMBER

CONFERMENT

E

AUG. 25,

RA 1080 79.40% DAVAO CITY

2002

(Continue on separate sheet if necessary) GOV'T

SERVICE

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

POSITION TITLE SALARY GRADE

INCLUSIVE DATES

30. DEPARTMENT / AGENCY / OFFICE / & STEP

MONTHLY STATUS OF

(mm/dd/yyyy) COMPANY INCREMENT

(Write in SALARY (Format "00- APPOINTMENT

(Write in full)

full) 0")

From To

6/24/2010 PRESENT TEACHER 1 DEPARTMENT OF EDUCATION YES /

(Yes

PERMANENT

No)

01/01/201

6/23/2010 TEACHER 1 DEPARTMENT OF EDUCATION YES

PERMANENT

0

01/07/200

12/31/2009 TEACHER 1 DEPARTMENT OF EDUCATION YES

PERMANENT

9

01/07/200

6/30/2009 TEACHER 1 DEPARTMENT OF EDUCATION YES

PERMANENT

8

07/01/200

12/31/2007 TEACHER 1 DEPARTMENT OF EDUCATION YES

PERMANENT

7

2/8/2004 6/30/2007 TEACHER 1 DEPARTMENT OF EDUCATION YES

PERMANENT

11/17/200

12/16/2003 TEACHER 1 DEPARTMENT OF EDUCATION YES

PERMANENT

3

8/11/2003 09/09/2003 TEACHER 1 SUBSTITUTE YES

SUBSTITUTE

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 2 of 4

CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

1. CS ID No.

Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. (to be filled up by CSC)

I. PERSONAL INFORMATION

2. SURNAME V I R G I N I A

FIRST NAME C H R I S T I N E

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

MIDDLE NAME

16. RESIDENTIAL ADDRESS

4. DATE OF BIRTH (mm/dd/yyyy) 12/19/1981

5. PLACE OF BIRTH KIDAPAWAN CITY ARC 2, PACO, KIDAPAWAN CITY

Male Female

6. SEX

7. CIVIL STATUS Widowed ZIP CODE 9400

Single

Married Separated 17. TELEPHONE NO. N/A

Others, specify 18. PERMANENT ADDRESS

Annulled

8. CITIZENSHIP FILIPINO ARC 2, PACO, KIDAPAWAN CITY

9. HEIGHT (m) 1.62

10. WEIGHT (kg) 62 ZIP CODE 9400

11. BLOOD TYPE O 19. TELEPHONE NO. NONE

acocgb@r.postjobfree.com

12. GSIS ID NO. 191********-**. E-MAIL ADDRESS (if any)

13. PAG-IBIG ID NO. 194*-****-**** 21. CELLPHONE NO. (if any)

091********

14. PHILHEALTH NO. 17-000******-*-**. AGENCY EMPLOYEE NO. Ed

Dep

15. SSS NO. 23. TIN 929-656-998

II. FAMILY BACKGROUND

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

DATE OF BIRTH

VIRGINIA

FIRST NAME KERZTEN SKY SKY VIRGINIA 04/07/2009

CHRISTINE

MIDDLE NAME / /

RACHO

OCCUPATION TEACHING / /

EMPLOYER/BUS. NAMEDEPARTMENT OF EDUCATION / /

BUSINESS ADDRESS / /

TELEPHONE NO. / /

(Continue on separate sheet if necessary) / /

26. FATHER'S SURNAME RACHO / /

FIRST NAME AQUILLIO / /

MIDDLE NAME RESERVA / /

27. MOTHER'S MAIDEN NAME / /

SURNAME PAJUTA / /

FIRST NAME CELSA / /

YEAR

MIDDLE NAME BUGAHOD (Continue on separate sheet if necessary)

GRADUATE

III. EDUCATIONAL BACKGROUND D HIGHEST SCHOLA

DEGREE GRADE/ RSHIP/

INCLUSIVE DATES OF

NAME OF SCHOOL COURSE LEVEL/ ACADEMI

28.

ATTENDANCE

LEVEL (Write in UNITS C

(Write in full) full) EARNED HONORS

From To

(if not RECEIVE

1993- graduated) D

LABU-O ELEM. SCHOOL

ELEMENTARY

1994

(if

graduated)

NOTRE DAME OF KIDAPAWAN FOR 1997-

SECONDARY

GIRLS 1998

VOCATIONAL/

TRADE COURSE

TERTIARY NOTRE DAME OF KIDAPAWAN MA ENGLISH 2001 2010

GRADUATED

GRADUATE STUDIES NOTRE DAME OF KIDAPAWAN MAED 24 UNITS 2002 2006

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