Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

REGION XII
“Matino, Mahusay at Maaasahan”
Prime Regional Government Center, Carpenter Hill, Koronadal City, 9506
Tel/Fax Nos.: (083)228-6660 • (083)228-1421 • Email: mail@region12.dilg.gov.ph • Website: region12.dilg.gov.ph
ADMIN (083) 228-7960 • FINANCE (083) 228-7959 • LGMED (083) 877-2969 • LGCDD (083)877 2971

SUMMARY OF PERSONAL INFORMATION AND QUALIFICATIONS

POSITION APPLIED : CONTACT TRACER

SALARY GRADE : 9
MONTHLY SALARY : PHP 18,784.00

NAME:
(Given Name, Middle Name, Surname)
ACTUAL RESIDENCE:

CELLPHONE NO.
EMAIL ADDRESS:
CIVIL STATUS: Married Single Widow/Widower Single Parent
BIRTHDAY: AGE:
(Month/Day/Year)
BIRTHPLACE:
EDUCATION:

EXPERIENCE/SKILLS: Please tick the box if applicable

Worked/working as COVID-19 Contact Tracer

Name of employer:
Completed a training on COVID-19 Contact Tracing
Agency/office who provided the training:
Date of training:
Skilled in data gathering and/or assisted in research and documentation
Able to interview COVID-19 cases and close contacts in order to gather
data on travel history and conduct health assessments.
Possess the ability to advocate public health education messages.
Have investigative capability.

OTHER INFORMATION: Please tick the box if applicable

Contract of Service personnel, whose contracts have not been renewed

or have been affected by the budget realignments due to COVID-19.
Returning Overseas Filipino Worker whose employment had been
disrupted.
Local company worker whose services have been recently terminated.

Note to Applicant: Please attach an updated accomplished Personal Data Sheet,

which can be downloaded at tinyurl.com/Revised2017

(Signature of Applicant over printed name)

Reviewed By:
(Date accomplished)

Provincial/HUC Administrative Officer

Date Reviewed

The DILG Region XII, imbued with integrity, competence and professionalism, and Living Up to a Peaceful, Accountable, and Dynamic
working environment, commits to deliver quality services through oversight function, capacity development intervention, incentives and
rewards and administrative assistance to local government units.

We uphold customer satisfaction and continual improvement of our Quality Management System’s effectiveness, compliant to applicable
laws, rules and regulations, and international standards, for a highly Developed, Orderly, Self-Reliant, Environment-friendly and Globally
Competitive SOCCSKSARGEN. (LUPAD DOSE).