Professional Documents
Culture Documents
Personal Data Sheet
Personal Data Sheet
Personal Data Sheet
with "
1. CS ID No.
I. PERSONAL INFORMATION
L
| A | S | T | I | E | R | E |
FIRST NAME
| O | V | E | N |
MIDDLE NAME
A | P
2. SURNAME
| I | S | T | A | R |
11/23/1991
|
|
|
|
|
|
|
|
|
|
6. SEX
7. CIVIL STATUS
Female
Single
Married
Widowed
Separated
8. CITIZENSHIP
Filipino
9. HEIGHT (m)
1.575 m.
|
|
|
|
|
|
|
|
|
|
|
|
Male
Annulled
ILOILO CITY
5. PLACE OF BIRTH
ZIP CODE
5000
+639053730083
Others, specify
___________
45 kg.
09496111845
N/A
joven_lastiere@wvsu.edu.ph
N/A
+639053730083
11-050558685
N/A
07-2729635
23. TIN
420270135
ZIP CODE
5000
FIRST NAME
N/A
N/A
MIDDLE NAME
N/A
OCCUPATION
N/A
EMPLOYER/BUS. NAME
N/A
BUSINESS ADDRESS
N/A
TELEPHONE NO.
N/A
8/17/1966
LASTIERE
DOMINGGO
MIDDLE NAME
EPACTA
APISTAR
FIRST NAME
CELIA
MIDDLE NAME
PALIZADA
12/29/1957
YEAR
GRADUATED
NAME OF SCHOOL
LEVEL
(Write in
DEGREE COURSE
(Write in full)
full)
ELEMENTARY
Elementary
SECONDARY
VOCATIONAL /
(if
graduated)
HIGHEST GRADE/
LEVEL/UNITS EARNED
(if not
graduated)
INCLUSIVE DATES OF
ATTENDANCE
From
To
2004
Graduated
1998
2004
Secondary
2008
Graduated
2004
2008
BSED-ENGLISH
2012
Graduated
2008
2012
SCHOLARSHIP/ ACADEMIC
HONORS RECEIVED
TRADE
COURSE
COLLEGE
GRADUATE STUDIES
RATING
DATE OF EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION /
CONFERMENT
NUMBER
DATE OF
RELEASE
76.00%
Sept. 30,2012
ILOILO CITY
1187204
4/16/2013
V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.
INCLUSIVE
DATES
(mm/dd/yyyy)
POSITION TITLE
(Write in full)
From
To
04/08/2013
03/31/14
7/27/2015
PRESENT
Departnment of Education
GOV'T
SERVICE
MONTHLY
SALARY
11,000
STATUS OF
APPOINTMENT
(Yes / No)
Probationary
NO
PERMANENT
YES
INCLUSIVE DATES
(Write in full)
NUMBER OF
HOURS
(mm/dd/yyyy)
From
To
10 / 26/ 2013
Present
Lector/ Commentator
(mm/dd/yyyy)
NUMBER OF
HOURS
CONDUCTED/ SPONSORED BY
(Write in full)
From
To
2/10/2012
2/12/2012
72
12/10/2011
12/14/2011
120
12/7/2013
12/7/2013
CARPENTRY NCII
9/1/2015
10/2/2015
10/26/2015
10/28/2015
32
SCHOOL INSET
10/29/2015
10/30/2015
16
TESDA
34.
35.
MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
Fashion
Photography
N/A
Graphic Designs
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4
36.
a.
b.
37
NO
NO
YES
NO
If YES, give details:
________________________________
________________________________
YES
NO
Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
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 term, finished contract, AWOL or
phased out, in the public or private sector?
40.
YES
NO
If YES, give details:
________________________________
________________________________
YES
NO
Have you ever been a candidate in a national or local election (except Barangay election)?
YES
NO
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
a.
b.
c.
NO
TEL. NO.
ADDRESS
6391890180
3960061
9106242597
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
27639174
COMMUNITY TAX CERTIFICATE NO.
ILOILO CITY
ISSUED AT
1/20/2015
11/2/2015
ISSUED ON (mm/dd/yyyy)
DATE ACCOMPLISHED
RIGHT THUMBMARK