Print legibly. Tick appropriate boxes and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. 2.
EDMAR JAMES
DEL MONTE
3.
16. CITIZENSHIP
4. PLACE OF BIRTH
5. SEX
17. RESIDENTIAL ADDRESS
8.
18. PERMANENT ADDRESS
Butuan Agusan del Norte
12. PHILHEALTH NO.
13. SSS NO. 19. TELEPHONE NO.
20. MOBILE NO.
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME
FIRST NAME
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
From To
ELEMENTARY 1990 1997 Graduated 1997
SECONDARY 1997 2001 Graduated 2001
VOCATIONAL /
TRADE COURSE 2013 2013 Completed 2013
200*-****-** units -
2003 2007 Graduated 2007
GRADUATE STUDIES -
CIVIL STATUS
PERIOD OF ATTENDANCE
HEIGHT (m)
BLOOD TYPE
GSIS ID NO.
PAG-IBIG ID NO.
Happy Homes Subd. Ambago
A+
DEL MONTE
MARISSA
GAMALINDA (Continue on separate sheet if necessary) EDGARDO
JR
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
6
7.
9.
10.
11.
26. HIGHEST LEVEL/
UNITS EARNED
(if not graduated)
YEAR
GRADUATED
SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED
COLLEGE
NAME OF SCHOOL
(Write in full)
BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in full)
1.62 meters
BUTUAN CENTRAL ELEMENTARY
SCHOOL
Completed
AGUSAN NATIONAL HIGH SCHOOL Completed
BUTUAN CENTRAL ELEMENTARY
SCHOOL(ALS PROGRAM)
Completed
Mindanao State University BS. Marketing
FATHER NATURNINO URIOS UNIVERSITY BS Management
PARCON
BUTUAN CITY
CAPARO
PONTIVEROS KOA BENJAMINE JAMES P. CAPARO 10/18/2013 TEACHER II
DEPARTMENT OF EDUCATION
14. TIN NO. 932-081-492 092********
*********@*****.***
CAPARO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) JANE DELL
NAME EXTENSION (JR., SR)
GWENNETH JANE P. CAPARO 07/23/2008
Subdivision/Village Barangay
City/Municipality Province
18-050041525-6 ZIP CODE 8600
08-1450712-6 085-***-****
WEIGHT (kg) 58 KG ZIP CODE 8600
Block 1 Lot 18
House/Block/Lot No. Street
Happy Homes Subd. Ambago
Block 1 Lot 18
House/Block/Lot No. Street
Subdivision/Village Barangay
Butuan Agusan del Norte
City/Municipality Province
MIDDLE NAME
DATE OF BIRTH
(mm/dd/yyyy) 06/21/1984
BUTUAN CITY If holder of dual citizenship, Pls. indicate country: please indicate the details.
PERSONAL DATA SHEET
WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the person concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
(Do not fill up. For CSC use only)
I. PERSONAL INFORMATION
SURNAME CAPARO
FIRST NAME
NAME EXTENSION (JR., SR)
CS Form No. 212
Revised 2017
Filipino Dual Citizenship
Male Female
Single Married
Widowed
Other/s:
Separated
by birth by naturalization
27.
NUMBER Date of
Validity
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. 28.
To
12/30/2020
5/16/2018
07/15/2018
10/30/2017
05/30/2016
08/14/2015
04/30/2011
01/29/2010
DATE
(Continue on separate sheet if necessary)
SIGNATURE
CS FORM 212 (Revised 2017), Page 2 of 4
RATING
(If Applicable)
MONTHLY
SALARY
SALARY/ JOB/ PAY
GRADE (if
applicable)& STEP
(Format "00-0")/
INCREMENT
STATUS OF
APPOINTMENT
GOV'T
SERVICE
(Y/ N)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER
SPECIAL LAWS/ CES/ CSEE
BARANGAY ELIGIBILITY / DRIVER'S LICENSE
DATE OF
EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
POSITION TITLE
(Write in full/Do not abbreviate)
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full/Do not abbreviate)
INCLUSIVE DATES
(mm/dd/yyyy)
03/03/2011 Sales Agent Kainin Trading (Right Med)
06/22/2007 Sales Agent SC Johnsons/ HERI Distribution 06/21/2017 Sales Consultant Chevrolet Cars Butuan
01/15/2016 Sales Agent LCG
04/29/2012 Purchaser ACLC Computer College Butuan
02/18/2020 Area Manager Growers Choice
1/15/2018 Business Development Specialist Asia Brewery 04/01/2018 Dining Manager Bigby's Butuan
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE
From
IV. CIVIL SERVICE ELIGIBILITY
LICENSE (if applicable)
From To
From To
02/09/2007 02/10/2007
02/02/2007 02/04/2007
12/09/2006 12/09/2007
02/18/2006 02/18/2006
31. SPECIAL SKILLS and HOBBIES 32. 33.
CS FORM 212 (Revised 2017), Page 3 of 4
(Continue on separate sheet if necessary)
SIGNATURE DATE
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
3rd MINDANAO BUSINESS AND MANAGEMENT YOUTH CONGRESS SEMINAR ON REQUIREMENTS IN STARTING A BUSINESS
HELPING MANAGING YOUR FAMILY RUN BUSINESS FOR CONTINUITY AND GROWTH
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions) 1st CARAGA COUNCIL OF DEANS AND BUSINESS EDUCATORS ASSOCIATION, INC (CCDBEA) 30.
NUMBER OF HOURS
Type of LD
( Managerial/
Supervisory/
Technical/etc)
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS
(Write in full)
CONDUCTED/ SPONSORED BY
(Write in full)
INCLUSIVE DATES OF
ATTENDANCE
(mm/dd/yyyy)
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 29.
NUMBER OF HOURS
NAME & ADDRESS OF ORGANIZATION
(Write in full) POSITION / NATURE OF WORK
INCLUSIVE DATES
(mm/dd/yyyy)
a.
If YES, please specify:
b.
If YES, please specify ID No:
c.
If YES, please specify ID No:
REFERENCES (Person not related by consanguinity or affinity to app ADDRESS
DRIVERS LICENCE
SUBSCRIBED AND SWORN to before me this, affiant exhibiting his/her validly issued government ID as indicated above. Person Administering Oath
CS FORM 212 (Revised 2017), Page 4 of 4
KO1-07-001768
BUTUAN
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance
Government Issued ID:
Signature (Sign inside the box)
Date/Place of Issuance: Date Accomplished Right Thumbmark ID/License/Passport No.:
42.
PHOTO
NAME TEL. NO.
LLOYD JAUGAN 918-***-****
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. I agree that any misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s against me.
40.
Are you a solo parent?
41.
Are you a person with disability?
Have you acquired the status of an immigrant or permanent resident of another country? 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: Are you a member of any indigenous group?
If YES, give details:
39.
If YES, give details (country):
b. Have you resigned from the government service during the three (3)-month period before the last election to promote/actively campaign for a national or local candidate? 38.
If YES, give details:
a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)?
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 or phased out (abolition) in the public or private sector?
If YES, give details:
37.
If YES, give details:
Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?
If YES, give details:
Date Filed:
Status of Case/s:
36.
b. Have you been criminally charged before any court? 35.
If YES, give details:
a. Have you ever been found guilty of any administrative offense? b. within the fourth degree (for Local Government Unit - Career Employees)? If YES, give details:
Bureau or Department where you will be apppointed, a. within the third degree?
34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the chief of bureau or office or to the person who has immediate supervision over you in the Office, YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES
YES
YES
NO
NO
NO
YES NO
YES NO