Professional Documents
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Personal Data Sheet (For Sample Purposes Only)
Personal Data Sheet (For Sample Purposes Only)
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME ALINGOG
NAME EXTENSION (JR., SR)
FIRST NAME MARIE JOY
Widowe Separa
d
House/Block/Lot No. Street
DISTRICT 3
Other/s
d ted Subdivision/Village Barangay
7. HEIGHT (Cm)
: 175 CM CAUAYAN CITY ISABELA
City/Municipality Province
8. WEIGHT (kg) 95 KGS ZIP CODE 3305
13. SSS NO. N/A 19. TELEPHONE NO. (078) 652 -0118
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) senseimajoy@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME ALINGOG 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR) JIREH MATHEUXS L. ALINGOG
FIRST NAME MARK AURELIUS 09/14/2014
ELIJAH ASHZRYIEL L. ALINGOG
MIDDLE NAME PASCUAL 05/28/2019
SURNAME RAMOS
SECONDARY /
VOCATIONAL MALLIG PLAINS COLLEGES,INC. 10/6/2004 5/4/2008 2008
TRADE
COURSE UNIVERSITY OF PERPETUAL HELP SYSTEM
COLLEGE
LAGUNA-ISABELA CAMPUS
BACHELOR OF SCIENCE IN NURSING 5/11/2008 4/4/2013 2013
SIGNATURE
DATE CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
GOV'T
SALARY/ JOB/ SERVICE
28. INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / PAY GRADE
POSITION TITLE
(mm/dd/yyyy) COMPANY MONTHLY (if applicable)& STATUS OF
(Write in full/Do not SALARY STEP (Format APPOINTMENT
(Write in full/Do not
abbreviate) "00-0")/
From To abbreviate) INCREMENT
(Y/ N)
PHILIPPINE TAEKWONDO
04/27/2017 PRESENT TAEKWONDO INSTRUCTRESS 100/session PER SESSION N
ASSOCIATION
4/3/2012 PRESENT PRIVATE TUTOR SELF EMPLOYED 100/session PER SESSION N
2000
01/25/2017 03/14/2018 EMERGENCY MEDICAL RESPONDER RESCUE 922 (Allowance) VOLUNTEER Y
COMMUNITY BASED MONITORING
5/3/2017 11/30/2018 LGU CAUAYAN 5000.00 VOLUNTEER Y
SYSTEM
EMERGENCY MEDICAL RESPONDER'S TRAINING January 16 2017 January 22 2017 3 Days Managerial RESCUE 922 CAUAYAN
R2 NATIONAL REFEREE AND REFRESHER COURSE November 16 2018November 18 2018 3 Days Managerial
Philippine Taekwondo Federation
FOUNDATION OF MASSAGE PRACTICE (1 of 4) September 15,202 September 15,2020 1 Day Technical TESDA
SMART TECHNOPRENEURSHIP 101 January 27, 2021 January 27, 2021 1 Day Managerial TESDA
PLAN TRAINING SESSION January 27, 2021 January 27, 2021 1 Day Managerial
TESDA
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:
PASTOR MAURO B. UBALDO VILLA CONCEPCION,LUNA ISABELA 9752526275 With full and handwritten
name tag and signature over
printed name
MR. AGUSTIN "JONG" PEREZ JR. TABUK,KALINGA 9171257772
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 administrative/criminal case/s PHOTO
against me.
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.