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Personal Data Sheet: Filipino Dual Citizenship by Birth by Naturalization
Personal Data Sheet: Filipino Dual Citizenship by Birth by Naturalization
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME MINGUA
NAME EXTENSION (JR., SR)
FIRST NAME CLAUDINE
9. BLOOD TYPE O+
18. PERMANENT ADDRESS SAGPAT
House/Block/Lot No. Street
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) minguaclaudinemanaois@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A
MIDDLE NAME
OCCUPATION N/A
SURNAME MANAOIS
ELEMENTARY STA MARIA ELEMENTARY SCHOOL PRIMARY EDUCATION 2003 2009 GRADUATED 2009
8TH
SECONDARY /
VOCATIONAL STA MARIA NATIONAL HIGH SCHOOL SECONDARY EDUCATION 2009 2013 GRADUATED 2013
HONORS
PANGASINAN TECHNOLOGICAL
FOOD PROCESSING NCII 1/10/2018 3/1/2018 GRADUATED 2018
INSTITUTE
TRADE
BACHELOR OF ELEMENTARY EXPANDED STUDENTS'
COURSE
COLLEGE PANGASINAN STATE UNIVERSITY 2013 2017 GRADUATED 2017 GRANTS-IN-AID PROGRAM
FOR POVERTY ALLEVIATION
EDUCATION (ESGP-PA)
LICENSURE EXAMINATION FOR TEACHERS 77.6 9/24/2017 ROSALES, PANGASINAN 1581162 9/12/2020
SCHOOL-BASED ICT TRAINING WORKSHOP 5/21/2018 5/25/2018 40.0 TECHNICAL STA MARIA NATIONAL HIGH SCHOOL
BASIC COMPUTER LITERACY AND COMPUTER ASSISTED INSTRUCTION 3/19/2018 3/28/2018 80.0 TECHNICAL MIKE INTERNET CAFÉ
TECHNICAL EDUCATION AND SKILLS
FOOD PROCESSING NCII 1/10/2018 3/1/2018 272.0 TECHNICAL
AUTHORITY
SINGING
ACTING
DANCING
READING
35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
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
YES ✘ NO
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, YES ✘ NO
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
YES ✘ NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
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?
YES ✘ NO
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?
YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:
DELIA L. DALUTAG SAN NICOLAS, PANGASINAN N/A With full and handwritten
name tag and signature over
printed name
LOIDA J. DE GUZMAN STA MARIA, PANGASINAN N/A
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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 PHOTO
administrative/criminal case/s against me.
SUBSCRIBED AND SWORN to before me this JANUARY 11, 2019 , affiant exhibiting his/her validly issued government ID as indicated above.