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. Print legibly. Tick appropriate boxes and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE 1. CS ID No. (Do no I. PERSONAL INFORMATION

2. SURNAME OCA

FIRST NAME LAWRENCE

NAME EXTENSION (JR., SR)

MIDDLE NAME DIAMADA

3. DATE OF BIRTH

(mm/dd/yyyy) 2/12/1985 16. CITIZENSHIP

4. PLACE OF BIRTH MATERNITY HOSPITAL, BUTUAN CITY If holder of dual citizenship, Pls. indicate country: 5. SEX

please indicate the details.

6 CIVIL STATUS 17. RESIDENTIAL ADDRESS PUROK 3 MARKETSI House/Block/Lot No. Street

POBLACIO

Subdivision/Village Barangay

7. HEIGHT (m)

1.67 m

CARMEN AGUSAN DEL N

City/Municipality Province

8. WEIGHT (kg)

67

ZIP CODE 8603

9. BLOOD TYPE B+

18. PERMANENT ADDRESS PUROK 3 MARKETSI

House/Block/Lot No. Street

10. GSIS ID NO. CRN-021-1977-2076-8

POBLACIO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121*-****-**** CARMEN AGUSAN DEL NORTE City/Municipality Province

12. PHILHEALTH NO. 180********* ZIP CODE 8603

13. SSS NO. 34-325****-*-**. TELEPHONE NO. NONE

14. TIN NO. 311-***-***-**. MOBILE NO. 091********-**. AGENCY EMPLOYEE NO. ON PROCESS 21. E-MAIL ADDRESS (if any) adymds@r.postjobfree.com II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME NONE

23. NAME of CHILDREN (Write full name and

list all) DATE OF B

FIRST NAME

NAME EXTENSION (JR., SR)

NONE

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME OCA

FIRST NAME VICENTE

NAME EXTENSION (JR., SR)

MIDDLE NAME CALO

25. MOTHER'S MAIDEN NAME

SURNAME DIAMADA

FIRST NAME PRINCESITA

MIDDLE NAME CALUMPANG (Continue on separate sheet if necessar III. EDUCATIONAL BACKGROUND

26.

LEVEL NAME OF SCHOOL

(Write in full)

BASIC EDUCATION/DEGREE/COURSE

(Write in full)

PERIOD OF ATTENDANCE HIGHEST LEVEL/

UNITS EARNED

(if not graduated)

YEAR

GRADUATED

From To

ELEMENTARY CARMEN CENTRAL ELEMENTARY SCHOOL ELEMENTARY 6/7/1991 3/30/1997 GRADUATED 1997 SECONDARY CARMEN ACADEMY (OLCACI) OUR LADY OF

CARMEN ACADEMY OF CARAGA INCORPORATED SECONDARY 6/7/1997 3/30/2001 GRADUATED 2001 VOCATIONAL /

TRADE COURSE NONE

COLLEGE DON BOSCO COLLEGE AB PHILOSOPHY 6/7/2002 3/30/2007 GRADUATED 2007 HOLY CHILD COLLEGES OF BUTUAN BS NURSING 6/7/2007 10/9/2011 GRADUATED 2011 ST. MICHAEL COLLEGE OF CARAGA CERTIFICATE OF TEACHER EDUCATION 6/7/2016 4/1/2017 GRADUATED 2017 GRADUATE STUDIES ST. JOSEPH INSTITUTE OF TECHNOLOGY MAED-VALUES EDUCATION 8/17/2019 8/1/2020 GRADUATED 2020

(Continue on separate sheet if necessary)

SIGNATURE DATE April 3, 20

CS FORM 21

CS Form No. 212

Revised 2017

ot fill up. For CSC use only)

ITE

ON

y

NORTE

e

ITE

ON

y

e

BIRTH (mm/dd/yyyy)

ry)

SCHOLARSHIP/ ACADEMIC

HONORS RECEIVED

1ST HONORABLE

MENTION

1ST HONORABLE

MENTION

022

12 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

27. CAREER SERVICE/ RA 1080 (BOARD/ BAR)

UNDER SPECIAL LAWS/ CES/ CSEE

BARANGAY ELIGIBILITY / DRIVER'S LICENSE

RATING

(If Applicable)

DATE OF

EXAMINATION /

CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

LICENSE (if applicable)

NUMBER Date of

Validity

LICENSURE EXAMINATION FOR TEACHERS 80.4 3/25/2018

CAPITOL UNIVERSITY, CAGAYAN DE ORO

CITY 1667728

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE

(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. 28. INCLUSIVE DATES

(mm/dd/yyyy) POSITION TITLE

(Write in full/Do not abbreviate)

DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full/Do not abbreviate)

MONTHLY

SALARY

SALARY/ JOB/ PAY

GRADE (if applicable)&

STEP (Format "00-0")

/ INCREMENT

STATUS OF

APPOINTMENT

GOV'T SERVICE

(Y/ N)

From To

1/10/2018 PRESENT TEACHER II DEP -ED AGUSAN DEL NORTE 29892.00 12-2 PERMANENT Y 6/13/2017 1/9/2018 TEACHER DEP-ED AGUSAN DEL NORTE NONE N/A VOLUNTEER N 10/15/2016 3/31/2017 MUNICIPAL TOURISM OFFICER LGU-CARMEN/TOURISM 8700.00 N/A CASUAL Y 6/15/2016 10/30/2016

SENIOR HIGH SCHOOL TEACHER/TESDA/

SPORTS COORDINATOR HOLY CHILD COLLEGES OF BUTUAN 8000.00 N/A CONTRACTUAL N 6/15/2016 10/13/2016 PART TIME COLLEGE

INSTRUCTOR HOLY CHILD COLLEGES OF BUTUAN 8000.00 N/A CONTRACTUAL N 4/24/2013 10/30/2015 SALESMAN/RESTAURANT IN-

CHARGE

KUWAIT FOOD S.A.K. AMERICANA

(CAMP ARIFJAN KUWAIT, KUWAIT

35000.00 N/A CONTRACTUAL N

12/1/2012 3/30/2013 SALES AGENT ANCHORLAND HOLDINGS INC. AYALA COR. MAKATI AVENUE,

16000.00 N/A CONTRACTUAL N

6/1/2012 8/30/2012 SALES AGENT CONVERGY'S GLORIETTA, MAKATI CITY

19000.00 N/A CONTRACTUAL N

3/1/2010 7/15/2011 MUNICIPAL TOURISM OFFICER LGU-CARMEN/TOURISM 6700.00 N/A CASUAL Y 5/15/2008 11/17/2008 CLERK LGU-CARMEN/HRMO STAFF 4500.00 N/A JOB ORDER Y

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 03, 2022

p

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 29. NAME & ADDRESS OF ORGANIZATION

(Write in full)

INCLUSIVE DATES

(mm/dd/yyyy) NUMBER OF HOURS POSITION

From To

N/A

(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) 30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS

(Write in full)

INCLUSIVE DATES OF

ATTENDANCE

(mm/dd/yyyy) NUMBER OF HOURS

Type of LD

( Managerial/

Supervisory/

Technical/etc)

From To

FOOD AND BEVERAGE SERVICES NC II 4/1/2016 5/30/2016 356 Technical Verand REGIONAL TOUR GUIDING SEMINAR 5/6/2011 6/18/2011 320 Technical Lucian

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION

(Write in full) 33. MEMB

Skirting N/A

Events Organizing

Hosting

Volleyball

Tour Guiding

Computer Literate

(Continue on separate sheet if necessary)

SIGNATURE DATE

N / NATURE OF WORK

CONDUCTED/ SPONSORED BY

(Write in full)

da CTL Tourism Training Center Inc.

na Convention Center, Butuan City

BERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

N/A

APRIL 03, 2022

CS FORM 212 (Revised 2017), Page 3 of 4

34. Are you related by consanguinity or affinity to the appointing or recommending authority, or chief of bureau or office or to the person who has immediate supervision over you in the Bureau or Department where you will be apppointed, a. within the third degree?

b. within the fourth degree (for Local Government Unit - Career Employees)? If YES, give details:

35. a. Have you ever been found guilty of any administrative offense? If YES, give details:

b. Have you been criminally charged before any court? If YES, give details:

Date Filed:

Status of Case/s:

36. 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: 37. 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:

END OF TERM, FINISHED CONTRACT

38. a. Have you ever been a candidate in a national or local election held within the last year

(except Barangay election)? If YES, give details:

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: 39. Have you acquired the status of an immigrant or permanent resident of another country? If YES, give details (country):

40. 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?

If YES, please specify:

b. Are you a person with disability?

If YES, please specify ID No:

c. Are you a solo parent?

If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) NAME ADDRESS TEL. NO.

PRINCESITA D. OCA POB. CARMEN, AGUSAN DEL NORTE 912-***-**** VINCENT ROBERT D. OCA CARMEN, AGUSAN DEL NORTE 910-***-**** MICHELLE OCA COJO CARMEN, AGUSAN DEL NORTE 938-***-**** 42. 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. PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance

Government Issued ID: PRC

ID/License/Passport No.1667728 Signature (Sign inside the box) Date/Place of Issuance: 08/08/2018 / Butuan City APRIL 03, 2022 Date Accomplished Right Thumbmark

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

ID picture taken within

the last 6 months

3.5 cm. X 4.5 cm

(passport size)

With full and handwritten

name tag and signature over

printed name

Computer generated

or photocopied picture

is not acceptable

Yes/No Cstat Gender

Yes Single Male

No Married Female

Separated

Widowed

Contact this candidate