Professional Documents
Culture Documents
PDS Khen Mark Paglumotan
PDS Khen Mark Paglumotan
PDS Khen Mark Paglumotan
I. PERSONAL INFORMATION
2. SURNAME PAGLUMOTAN
FIRST NAME KHEN MARK
MIDDLE NAME TOLEDO 3. NAME EXTENSION (e.g. Jr., Sr.)
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
TALUBANGI ELEMENTARY
ELEMENTARY 2009 2003 2009
SCHOOL
VOCATIONAL/ TRADE
COURSE
BACHELOR IN
CEBTRAL PHILIPPINES
COLLEGE PHYSICAL 2017 2013 2017 CUM LAUDE
STATE UNIVERSITY
EDUCATION
GRADUATE STUDIES
V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")
PAGLUMOTAN, KHEN MARK TOLEDO - T15255526 CS FORM 212 (Revised 2005), Page 2 of 3
36. Are you related by consanguinity or affinity to any of the following :
38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
_____________________________________
_____________________________________
39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
_____________________________________
_____________________________________
40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________
_____________________________________
41. 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:
43. 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.
X
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that
this information shall remain confidential. PHOTO
PAGLUMOTAN, KHEN MARK TOLEDO - T15255526 CS FORM 212 (Revised 2005), Page 3 of 3