Office Service
Resume:
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.
KATRINA JOY
TAMBOT
3.
16. CITIZENSHIP
4. PLACE OF BIRTH
5. SEX
17. RESIDENTIAL ADDRESS
8.
18. PERMANENT ADDRESS
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.
SURNAME
FIRST NAME
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
From To
ELEMENTARY 6/8/1996 3/20/2001 2001
SECONDARY 6/5/2002 3/15/2005 2005
VOCATIONAL /
TRADE COURSE
COLLEGE 6/1/2005 4/9/2009 2009
GRADUATE STUDIES
CS FORM 212 (Revised 2017), Page 1 of 4
SIGNATURE
(Continue on separate sheet if necessary)
January 27, 2021
VICENTE
DELA CRUZ
DATE
HIGHEST LEVEL/
UNITS EARNED
(if not graduated)
GALVEZ
TAMBOT
JOSEFA
NAME EXTENSION (JR., SR)
BASIC EDUCATION/DEGREE/COURSE
(Write in full)
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.
LEVEL
NAME OF SCHOOL
(Write in full)
DON GREGORIO EVANGELISTA MEMORIAL
SCHOOL
ZAMBOANGA STATE COLLEGE OF MARINE
SCINECES AND TECHNOLOGY
WESTERN MINDANAO STATE UNIVERSITY
Barangay
ZAMBOANGA CITY ZAMBOANGA DEL SUR
City/Municipality Province
City/Municipality Province
GALVEZ DRIVE
ZIP CODE
955-1674
STA. MARIA
************@*****.***
23. NAME of CHILDREN (Write full name and list all) PERSONAL DATA SHEET
I. PERSONAL INFORMATION
(Do not fill up. For CSC use only)
SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED
DATE OF BIRTH (mm/dd/yyyy)
26. YEAR
GRADUATED
GALVEZ
35906
SURNAME
FIRST NAME
MIDDLE NAME
ZIP CODE
NAME EXTENSION (JR., SR)
14. TIN NO. 312147770
RTRYX JANN
SPIRIG
KEAN RANDALL SIOSE
1.57
9.
HEIGHT (m)
WEIGHT (kg)
BLOOD TYPE
GSIS ID NO.
PAG-IBIG ID NO.
ZAMBOANGA CITY
House/Block/Lot No. Street
Subdivision/Village Barangay
ZAMBOANGA CITY
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM. Street
STA. MARIA
Subdivision/Village
10.
11.
B
NA
6
7.
CIVIL STATUS
DATE OF BIRTH
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
9/28/1988
BACHELOR OF SCIENCE IN NURSING
DUNGGON (Continue on separate sheet if necessary)
PERIOD OF ATTENDANCE
MOTHER'S MAIDEN NAME
991-2471
11/20/2013
please indicate the details.
If holder of dual citizenship, Pls. indicate country: GALVEZ DRIVE
79
ZAMBOANGA DEL SUR
7000
SIOSE
EMT-TRANEE
ZAMBOANGA PUERICULTURE
LA PURISAMA STREET, Z.C
House/Block/Lot No.
7000
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
75.9 0618269 7/9/1905
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. 28.
To
1/20/2021 12000.00 REGULAR N
8/15/2016 100000.00 REGULAR N
3/12/2013 180000.00 REGULAR N
12/9/2013 16000.00 PROBI N
DATE
CS FORM 212 (Revised 2017), Page 2 of 4
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER
SPECIAL LAWS/ CES/ CSEE
BARANGAY ELIGIBILITY / DRIVER'S LICENSE
DATE OF
EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
LICENSE (if applicable)
RATING
(If Applicable)
IV. CIVIL SERVICE ELIGIBILITY
GOV'T
SERVICE
(Y/ N)
ZAMBOANGA CITY
SALARY/ JOB/ PAY
GRADE (if
applicable)& STEP
(Format "00-0")/
From INCREMENT
POSITION TITLE
(Write in full/Do not abbreviate)
NURSING LICENSURE EXAMINATION 11/29-30/2009
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full/Do not abbreviate)
MONTHLY
SALARY
OPERATING ROOM/FINANCE DEPARTMENT/CIUDAD
MEDICAL ZAMBOANGA
INCLUSIVE DATES
(mm/dd/yyyy)
1/9/2017
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE
OPERATING ROOM INVENTORY
ASSOCIATE
8/6/2012
11/17/2015 STORE HEAD/ BRANCH SUPERVISOR CECILE'S PHARMACY/STA. MARIA CUSTOMER SERVICE REPRESENTATIVE SITEL PHILIPPINES/MANDALUYONG CITY STATUS OF
APPOINTMENT
SIGNATURE
MEDICAL REPRESENTATIVE NATRAPHARM-PATRIOT GROUP INC
(Continue on separate sheet if necessary)
7/6/2012
January 27, 2021
From To
From To
31. SPECIAL SKILLS and HOBBIES 32. 33.
CS FORM 212 (Revised 2017), Page 3 of 4
DATE January 27, 2021
(Continue on separate sheet if necessary)
WRITING
MS OFFICE PROFICEINT
NON-ACADEMIC DISTINCTIONS / RECOGNITION
(Write in full)
BASIC EDITING AND PROOFREADING
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
NUMBER OF HOURS
SIGNATURE
INTRA-SCHOOL WRITING COMPETITION
VIII. OTHER INFORMATION
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS
(Write in full)
Type of LD
( Managerial/
Supervisory/
Technical/etc)
29. NAME & ADDRESS OF ORGANIZATION
(Write in full)
(Continue on separate sheet if necessary)
POSITION / NATURE OF WORK
INCLUSIVE DATES
(mm/dd/yyyy)
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S CONDUCTED/ SPONSORED BY
(Write in full)
INCLUSIVE DATES OF
ATTENDANCE
(mm/dd/yyyy)
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED NUMBER OF HOURS
30.
RESIGNATION
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 applicant /appointee) ADDRESS
STA. CATALINA, Z.C
CANELAR, Z.C.
STA. MARIA, Z.C.
SSS UMID ID
CS FORM 212 (Revised 2017), Page 4 of 4
Person Administering Oath
SUBSCRIBED AND SWORN to before me this, affiant exhibiting his/her validly issued government ID as indicated above. Date Accomplished Right Thumbmark
Date/Place of Issuance: MAY 2018/ZAMBOANGA CITY
Government Issued ID:
ID/License/Passport No.:
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance
0111-648906-7
Signature (Sign inside the box)
January 27, 2021
PHOTO
NAME TEL. NO.
42.
MARITHEL TEVES
GENALYN PANGILINAN 997*******
JUNAS RABANES
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.
41.
38.
If YES, give details:
If YES, give details:
Date Filed:
Status of Case/s:
b. Have you been criminally charged before any court? If YES, give details:
If YES, give details:
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?
a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)?
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? If YES, give details (country):
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?
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)? 36.
37.
Are you a person with disability?
Are you a solo parent?
40.
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?
39.
If YES, give details:
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, a. within the third degree?
Bureau or Department where you will be apppointed, ID picture taken within
the last 6 months
4.5 cm. X 3.5 cm
(passport size)
Computer generated
or photocopied picture
is not acceptable
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES
YES
YES
NO
NO
NO
YES NO
YES NO
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