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CS Form No. 212 Revised Personal Data Sheet - New
CS Form No. 212 Revised Personal Data Sheet - New
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME INGKONG
NAME EXTENSION (JR., SR)
FIRST NAME NHORHANIE
6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS PUROK 18 MORAGA
Widowed Separated House/Block/Lot No. Street
N/A TINAGACAN
Other/s:
Subdivision/Village Barangay
GENERAL SANTOS CITY SOUTH COTABATO
7. HEIGHT (m) 1.53
City/Municipality Province
8. WEIGHT (kg) 40 ZIP CODE 9500
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) ingkongnhorhanie@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 N/A
OCCUPATION N/A
SURNAME INGKONG
ELEMENTARY DATU DUMAGKAL DANIAL ELEMENTARY SCHOOL PRIMARY EDUCATION 9/6/2004 03/24/2010 COMPLETED 2010 N/A
BARANGAY
SECONDARY /
VOCATIONAL DATU ANDIAM MANZA NATIONAL HIGH SCHOOL HIGH SCHOOL 12/6/2010 03/27/2014 GRADUTED 2014
SCHOLAR
PRACTICE TEACHING 01/27/2018 03/30/2019 280.0 FOUNDATIONAL FATIMA CENTRAL ELEMENTARY SCHOOL, G.S.C
FIELD STUDY 2 01/27/2016 02/24/2016 17.0 FOUNDATIONAL UPPER TAMBLER ELEMENTARY SCHOOL II G.S.C.
FIELD STUDY 1 10/28/2015 11/25/2015 17.0 FOUNDATIONAL NASA ELEMENTARY SCHOOL G.S.C.
DANCING
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: MAGUINDANAON
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:
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 , affiant exhibiting his/her validly issued government ID as indicated above.
LINAMEN C. CATAS, AO V
Person Administering Oath