Service Office
Resume:
PERSONAL DATA SHEET
q with "P " and use separate form if necessary. 1. CS ID No.
Print legibly. Mark appropriate boxes (to be fi
I. PERSONAL INFORMATION
OLIVEROS
2. SURNAME
ANGELICA
FIRST NAME
ESPLANA 3. NAME EXTENSION (e.g. Jr., Sr.)
MIDDLE NAME
16. RESIDENTIAL ADDRESS
4. DATE OF BIRTH (mm/dd/yyyy) 12/11/1996
5. PLACE OF BIRTH STA. CRUZ, MARINDUQUE BOCOHAN, LUCENA CITY
Male $ Female
6. SEX
7. CIVIL STATUS $ Single Separated ZIP CODE 4301
Married Widowed 17. TELEPHONE NO.
Others specify:
18. PERMANENT ADDRESS
Annuled
8. CITIZENSHIP FILIPINO BOCOHAN, LUCENA CITY
9. HEIGHT (m) 5ft
10. WEIGHT (kg) ZIP CODE 4301
11. BLOOD TYPE 19. TELEPHONE NO.
12. GSIS ID NO. 20. E-MAIL ADDRESS (if any) ************@*****.***
13. PAG-IBIG ID NO. 21. CELLPHONE NO. (if any) 094********
14. PHILHEALTH NO. 22. AGENCY EMPLOYEE NO.
15. SSS NO. 23. TIN
II. FAMILY BACKGROUND
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.
(Continue on separate form if necessary)
26. FATHER'S SURNAME OLIVEROS
FIRST NAME NELSON
MIDDLE NAME LACDAO
27. MOTHER'S MAIDEN NAME
SURNAME ESPLANA
FIRST NAME TEODORA
MIDDLE NAME PEREDA (Continue on separate form if necessary)
YEAR
GRADUATED
III. EDUCATIONAL BACKGROUND
HIGHEST GRADE/ INCLUSIVE DATES OF
28. NAME OF SCHOOL DEGREE COURSE LEVEL/ ATTENDANCE
LEVEL (Write in UNITS EARNED
(Write in full) full) (if not From
graduated)
(if
ELEMENTARY GABALDON ELEMENTARY SCHOOL 2008
graduated)
SECONDARY SANTA CRUZ INSTITUTE 2009
VOCATIONAL /
COLLEGE TRADE BACHELOR OF SCIENCE
DALUBHASAAN NG LUNGSOD NG
COURSE 2013
IN INFORMATION
LUCENA TECHNOLOGY
GRADUATE STUDIES
LUCENA MANPOWER SERVICE BASIC COMPUTER
TRAINING CENTER APPLICATION
COMPUTER
HARDWARE
SERVICING
(Continue on separate form if necessary)
(to be filled up by CSC)
ION (e.g. Jr., Sr.)
DATE OF BIRTH (mm/dd/yyyy)
te form if necessary)
SIVE DATES OF
SCHOLARSHIP/
TTENDANCE
ACADEMIC HONORS
RECEIVED
To
2009
2013
2017 FULL SCHOLAR
2014 FULL SCHOLAR
2014 FULL SCHOLAR
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
(Continue on separate form if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE
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
(Yes / No)
(Continue on separate form if necessary)
CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY O
INCLUSIVE DATES
31. NAME & ADDRESS OF ORGANIZATION NUMBER OF
POSITION / NATURE OF W
(Write in full) HOURS
(mm/dd/yyyy)
From To
(Continue on separate form 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 B
(Write in full) HOURS (Write in full
(mm/dd/yyyy)
From To
(Continue on separate form if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION: ASSOCIATION/ORGANIZAT
33. SPECIAL SKILLS / HOBBIES: 34. 35.
(Write in full)
(Write in
(Continue on separate form if necessary)
CS FORM 212 (Revised 2005), P
IVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
POSITION / NATURE OF WORK
separate form if necessary)
st recent training.)
CONDUCTED/ SPONSORED BY
(Write in full)
separate form if necessary)
MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
separate form if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4
36. Are you related by consanguinity or affinity to any of the following :
NO
YES
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?
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:
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, 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:
resignation, retirement, dropped from the rolls, dismissal, termination, end of YES NO
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.
ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)
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
If YES, give details:
If YES, give details:
If YES, give details:
If YES, give details:
If YES, give details:
If YES, give details:
__
If YES, give details:
If YES, please specify:
If YES, please specify:
If YES, please specify:
intee)
CS FORM 212 (Revised 2005), Page 4 of 4
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