Service Office
Resume:
PERSONAL DATA SHE
*. CS ID No.
q with "P " and use separate sheet if necessary.
Print legibly. Mark appropriate boxes
I. PERSONAL INFORMATION
YSMAEL
2. SURNAME
PATRICIA
FIRST NAME
LUCIANO 3. NAME EXTENSION (e.g. Jr
MIDDLE NAME
16. RESIDENTIAL ADDRESS
#38 PNR STREET STO. NINO
12/05/1987
4. DATE OF BIRTH (mm/dd/yyyy)
CITY OF SAN FERNANDO, PAMPANGA
5. PLACE OF BIRTH
Male Female
6. SEX
7. CIVIL STATUS
2000
Single Annuled ZIP CODE
NONE
Married Widow 17. TELEPHONE NO.
18. PERMANENT ADDRESS
#38 PNR STREET STO. NINO
Separated Others:
FILIPINO
8. CITIZENSHIP
5'5''
9. HEIGHT (m)
2000
55 kg
10. WEIGHT (kg) ZIP CODE
NONE
B+
11. BLOOD TYPE 19. TELEPHONE NO.
*****************@*****.***
N/A
12. GSIS ID NO. 20. E-MAIL ADDRESS (if any)
13. PAG-IBIG ID NO. 21. CELLPHONE NO. (if any)
4262897
14. PHILHEALTH NO. 22. AGENCY EMPLOYEE NO.
250 446 330
02 2593976 5
15. SSS NO. 23. TIN
II. FAMILY BACKGROUND
YSMAEL
24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all)
PAUL SANDLER L. YSMAEL
SANDY CHRISTIAN
FIRST NAME
ESPINOSA
MIDDLE NAME
N/A
OCCUPATION
N/A
EMPLOYER/BUS. NAME
N/A
BUSINESS ADDRESS
N/A
TELEPHONE NO.
(Continue on separate sheet if necessary)
LUCIANO
26. FATHER'S SURNAME
JUNE
FIRST NAME
NAVARRO
MIDDLE NAME
27. MOTHER'S MAIDEN NAME
DE JESUS
SURNAME
LUZVIMINDA
FIRST NAME
TORRES
MIDDLE NAME (C
YEAR
III. EDUCATIONAL BACKGROUND GRADUATED
HIGHEST GRADE/
28. NAME OF SCHOOL DEGREE COURSE LEVEL/
LEVEL (Write in UNITS EARNED
(Write in full) full) (if not
graduated)
SAN FERNANDO ELEMENTARY (if
6TH GRADE graduated) GRADUATED
2000
ELEMENTARY
SCHOOL
PAMPANGA HIGH SCHOOL
2004
4TH YEAR GRADUATED
SECONDARY /
VOCATIONAL
BACHELOR OF
COLLEGE
UNIVERSITY OF THE ASSUMPTION
2008 GRADUATED
TRADE COURSE ELEMENTARY
EDUCATION
GRADUATE STUDIES
(Continue on separate sheet if necessary)
ONAL DATA SHEET
(to be filled up by CSC)
3. NAME EXTENSION (e.g. Jr., Sr.)
#38 PNR STREET STO. NINO CITY OF SAN FERNANDO PAMPANGA
2000
NONE
#38 PNR STREET STO. NINO CITY OF SAN FERNANDO PAMPANGA
2000
NONE
*****************@*****.***
4262897
250 446 330
NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
PAUL SANDLER L. YSMAEL 12/10/2008
(Continue on separate sheet if necessary)
HIGHEST GRADE/ INCLUSIVE DATES OF
LEVEL/ ATTENDANCE
UNITS EARNED SCHOLARSHIP/ ACADEMIC HONORS RECEIVED
(if not From To
graduated)
GRADUATED 1994 2000
GRADUATED 2000 2004
GRADUATED 2004 2008
ontinue on separate sheet if necessary)
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
LICENSE (if applicable)
29. DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
NUMBER
CONFERMENT
RELEASE
78.60% Manila
LICENSURE EXAMNINATION FOR TEACHERS Sept. 30, 201*-******* 7/13/2013
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work)
GOV'T SERVICE
INCLUSIVE DATES POSITION TITLE
30. SALARY GRADE
DEPARTMENT / AGENCY / OFFICE / & STEP
(mm/dd/yyyy) MONTHLY STATUS OF
COMPANY INCREMENT
(Write in SALARY (Format "00- APPOINTMENT
(Write in full)
full) 0")
From To
(Yes / No)
6/1/2008 3/31/2014 TEACHER 12,650 N/A NO
SHEPHERD'S LIGHT LEARNING CENTER PERMANENT
Department of Education/
07/01/2014 Present TEACHER I 18,549 11 YES
PERMANENT
CSFWIS
(Continue on separate sheet if necessary)
TARCILA P. JAVIER CS FORM 212 (Revised 2005), Page 2 of 4
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
N/A N/A N/A N/A
NONE
(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
Division of City of San
Institutional Spirituality Enhancement Program 12/05/2015 12/19/2015 24 Hours
Fernando Pampanga
Division of City of San
10/28/2015 10/30/2015 24 Hours
Teachers' Induction Program Fernando Pampanga
Division of City of San
3 Day Comprehensive Disaster Management and Climate Change
Fernando Pampanga
Adaptation Training 10/26/2015 10/28/2015 24 Hours CDRRMO
Division of City of San
Seminar on Content
04/23/2015 04/25/2015 24 Hours
Fernando Pampanga
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION: ASSOCIATION/ORGANIZATION
33. SPECIAL SKILLS / HOBBIES: 34. 35.
(Write in full)
(Write in full)
COMPUTER LITERATE NONE
(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 :
YES NO
a. Within the third degree (for National Government Employees):
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?
YES NO
b. Within the fourth degree (for Local Government Employees):
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:
YES NO
a. Are you a member of any indigenous group?
If YES, please specify:
Are you differently abled?
b. YES NO
If YES, please specify:
c. Are you a solo parent? YES NO
If YES, please specify:Separated
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME ADDRESS TEL. NO.
Teresta T. Tungol Villa Julita Subd. CSFP 091*-***-****
Teresita S. Tablante San Fernando Subd. CSFP 091*-***-****
Aiza D. Canlas Calulut, CSFP 092*-***-****
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. PHOTO
13487588
COMMUNITY TAX CERTIFICATE NO.
CSFP
ISSUED AT SIGNATURE (Sign inside the box)
01/11/2016 06/02/2016
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK
TARCILA P. JAVIER
CS FORM 212 (Revised 2005), Page 4 of 4
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