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CS Form No. 212 Revised Personal Data Sheet 2 (2) - MELYN
CS Form No. 212 Revised Personal Data Sheet 2 (2) - MELYN
CS Form No. 212 Revised Personal Data Sheet 2 (2) - MELYN
212
Revised 2017
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)
I. PERSONAL INFORMATION
2. SURNAME BAYONA
NAME EXTENSION (JR., SR)
FIRST NAME MELYN
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) bayonamelyn27@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
BUSINESS ADDRESS SITIO SAN RAMON, BRGY. MANALAD, ILOG, NEG. OCC.
MIDDLE NAME GA
SURNAME MENDOZA
SECONDARY /
VOCATIONAL KABANKALAN CATHOLIC COLLEGE 2002 2006 GRADUATED 2006
TRADE
COURSE
BS IN BUSINESS ADMINISTRATION MAJOR IN CITY
COLLEGE BINALBAGAN CATHOLIC COLLEGE HUMAN RESOURCE DEVELOPMENT MANAGEMENT 2006 2010 GRADUATED 2010
SCHOLARS
GRADUATE STUDIES
5 /15 /2010 02/08/2012 Ticket Teller, Tabulator, Cashier VALLACAR TRANSIT CORP. 8,000.00 N
COMMUNITY EMPOWERMENT
9/ 20 /2014 12/31/2016 DSWD KALAHI-CIDSS 22,328.00 Y
FACILITATOR-ACT
01/03/2018 12/31/2018 MUNICIPAL FINANCE ANAYST-MCT LGU ILOG-DSWD KALAHI CIDSS 13,100.00 Y
COMMUNITY EMPOWERMENT
03/13/2020 12/31/2020 DSWD KALAHI-CIDSS 26,000 Y
FACILITATOR-ACT
DSWD NCDDP ROLL-OUT TRAINING ON REGULAR CEAC FOR ACT STAGE 3-4 06/19/2016 06/24/2016 DSWD
Roll-out Training for ACT/MCT for Project Closure and Sustainability and Transition to
9 / 16 /2015 9/ 22 /15 DSWD
Cycle 2 Regular CEAC for Cluster E
ROLL-OUT TRAINING FOR ACT PART 2 ENVIRONMENTAL SAFEGUARD AND
3/ 9 /2015 3 / 15 / 2015 DSWD
SAFETY TRAINING
KALAHI-CIDSS NCDDP ROLL-OUT TRAINING FOR AREA COORDINATING TEAM
9/ 24/2014 10 / 03 /14 DSWD
NEGROS PROVINCE (BATCH 7)
REFRESHER COURSE FOR ACT'S AND MCT'S IN PREPARATION FOR KALAHI-
6/ 24 /2013 6 / 30 /13 DSWD
CIDSS CYCLE 2
TYPING
COMPUTER LITERATE
ENCODING
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:
JOHN MARK B. OGATIS LA CASTELLANA. NEG. OCC 9506423149 With full and handwritten
name tag and signature over
printed name
TEODORA R. PADILAA ILOG, NEG. OCC
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.