Professional Documents
Culture Documents
CS Form No. 212 Revised Personal Data Sheet New
CS Form No. 212 Revised Personal Data Sheet New
CS Form No. 212 Revised Personal Data Sheet New
212
Revised 2017
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 2811-E
House/Block/Lot No.
N/A
Subdivision/Village
7. HEIGHT (m) 1.72 MANILA
City/Municipality
8. WEIGHT (kg) 70 ZIP CODE 1014
9. BLOOD TYPE O
18. PERMANENT ADDRESS 2811-E
House/Block/Lot No.
N/A
10. GSIS ID NO. N/A
Subdivision/Village
15. AGENCY EMPLOYEE NO. 000-088-079-000 21. E-MAIL ADDRESS (if any) gjenerrick_mateo@roc
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
FIRST NAME NAME EXTENSION (JR., SR) SAMANTHA BRIDGETTE CAROL MATE
N/A
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
SURNAME MATEO
TRADE
COURSE
COLLEGE EMILIO AGUINALDO COLLEGE BACHELOR OF SCIENCE IN CRIMINOLOGY 2011
SIGNATURE DATE
HEET
the filing of administrative/criminal case/s against the person
1014
N/A
09151744506
gjenerrick_mateo@rocketmail.com
CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
1/25/1966
CUM
2015 GRADUATED 2015
LAUDE
OCTOBER
BOARD OF CRIMINOLOGY 87.3 17,18,19, 2015
MANILA
10011315134
ANILA 12/15/2015
3
CONTRACTU
N/A NO
AL
January 16, 2018
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS
From To
N/A
BASKETBALL N/A
COMPUTER LITERATE
SIGNATURE DATE
NTARY ORGANIZATION/S
ED
Chief/Executive/Managerial positions)
Type of LD
( Managerial/ CONDUCTED/ SPONSORED BY
Supervisory/ (Write in full)
Technical/etc)
N/A
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 If YES, give details:
out (abolition) in the public or private sector? ________________________________
________________________________
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
a.
8972), please answer the following items:
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:
42.
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated a
S, give details:
__________________________
__________________________
S, give details:
__________________________
__________________________
S, give details:
__________________________
__________________________
S, give details:
__________________________
__________________________
Computer generated
or photocopied picture
is not acceptable
ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)
Computer generated
or photocopied picture
is not acceptable
PHOTO
Right Thumbmark