eS Form No 2 PERSONAL DATA SHEET READ THE ATTACHED GUIDE TO FLING OUT THE PERSONAL DATA SHEET (908) BEFORE ACCOMPLISHING THE POS FORM war: Any mirerecentton mad in te Personal Dts Sheet nd te Work Expavance Shas shal cau tein of minal atl punt porn 2 ame seretu nee = ===> oo. Fac re haere — ae ees yee Coytion 7 pucorann STA IGNAGATARLAG tea, Ps nda coy 5 sek O Mate Dl Female eee Peru vv com sn Tse Trem! rao 36 ae cima sees esa oar Ol omer aoe ry fem a ros oc ls zoe fae iene = RET OO mae ra fe sore eo.za2 720 Tene ea 11 PAGIBIGIONO. 121061804356 SR IGNAC hnonced epee — fa pavennie 7 recone fa fa ssa jmasiraa ference (eaaorsees fer breseaaas 0 = etsonoens necranome (WA fr eanc noes ee fe soiscesmne Jesrenty Feo croR ce me OHTECE BRT sr ae [aaRouD [nn [CewnanLy ESPIRTU lowzwaor0 one Ne jeurar [SZWYLEEF ESPIRTU [orowaois coamTen POLICE STAFF SERGEANT ‘aecovenecanessraue _|PHIIPPINE NATIONAL POLICE aes CoS [SKATUNA VILL CAMP GEN. TOMAS KARINGAL QUEZON CTY THEMEN wa fe evesamane | FACUM oo ama RT mooie [ROWBADA ums [CACAYANGA se [wcrORINA Moo Ne ex (Connon tne — ‘wm ta ime ARTSEIMED JormcunreD| Nouns sown era mes est eworany sot lasuonse eo | 06 | crores | sm05 fa ono era mes arena soe Jc sonoe 90s | se | cmoureo | 1H60 fwnstovons Vocanana lus lus wa | wa | ome wa |wa Jorccusarsorrawaaromosrenns [excisionorsecononnyeoucaron | anir | 217 SIGNATURE DATECAREER SERVICE RA 1080 (BOARDVBARIUNDER | parnyg DATE OF TUCENSE pote) ‘SPEOWLLANS/CES/CSEE ee, | eamaren PLACE OF EXAMINATION CORFERVENT Ee BARANGAY EUIGBUTY ORNVERS LICENSE (Whee) | conrenwent mower | Gast NA Na NA NA mn rosrovrne verameracecrvercevcarnnr | vom |e | simsor | (wien twat Sat | pit | una, | 1s Ser cio | orate TEER TarexLanmoucnerseco: | aaao | ww [momreunr] —y cima | soar TAGE ee de owas TEASER TaenLAvnRTOWALHGHSoWOL | aiew | mer _[moamnounr| oven | a TeAciERE ed ovens | rasare THERE vaveLavnTonaLworsereo. | zaman | war | momrownr| carvan | aa Teer ed vow | omar Teo TNoALanmoLnersoo. | zuew | wow [pmommou| cara? | mir TEACH TANEALANARTONALHGRSSHOOL | area | waar [Pomme] caw | ean oonerER weecacworonsaLesoonm | vammae | wo | mona [| oxo | wants cask wzLrcworonsaLesoor» | omar | ooo” | weouan | re SIGNATURE oye‘re yourelalod by consanguiiy or afiniy (othe apponiing or recommending authorly, or to He chief of bureau or ofie orto the person who has ied supervision over you in the Otfce, ‘Bureau or Department where you wil be apppoind, ‘a.wtin the third degree? within the fouth degre (or Local Government Uni - Career Employees)? Os Owe IFYES, give deta ‘a Have you ever been found quly of any administrative offense? Ow INVES, give datas b, Have you been criminally charged before any court? Ove IFYES, give dota: Dato Fed Status of Casals: <8, Have you eet Been cone oay insolation of ary aw, eee ordnance oreqUaion | vex Dw ae aa IVES, ove deta: "Have you ever been separaied rom the sovice any ofthe folowing modes: resignation, Oe ‘ebrement, cropped from the rol, isissa, termination, end of term, finished contractor phased out| YES, give deta: (eboition inthe public or prvale sector? <3. a Haveyou evr boon a candeein a national roel election hed win Be aslyear(oxoonl | Ty veg Barangay election)? TKYES, give details: 'b, Have you resigned from the goverment service during the three (3)month period before thelast | [] ves ‘locon to promotlacvely campaign for a national or local candidat? IVES, give deta: “a2 Have you acquired he satus ofan migrant or permanent resident of naar couniry? Ow IVES, give dota (county): ‘Pursvant to a) Indigenous People's Act (RA 371, 0) Magna GaraTor Disabled Persons (RA 7277) and (¢) Solo Parents Welfare Act of 2000 (RA 8972), please answer te folowing ems: ‘Ae you a ember of any indigenous group? ‘Are you a person wih disability? ‘Ae you a soo parent? |, REFERENCES (Pucon rol bycnzanguntyeafint appar aponies) TAME "ADDRESS Ove I YES, please speci Ow lr VES, please spec ID No Ove I YES, lease spect ID No TELNO, Serevent [srames eas sTA 1oNAciA TARLAC ooszs1s763 feocanm.cuavo1o Jaauoios sta sonacia TARLAC or7siats65 |JonaTaAn'. JacinTo [staInes EASTSTA.IoNACK,TARLAG "ET declare under oa thal | have personaly aocompished ‘dminisratveoriminal casols against me. ——=—=_= == a JoricorcePassparne: oon zmasr20 lore4s2ta80 Tis Personal Data Shoot which 6 a bus, coved ard complete stalement pursuant to the provisions of pertinent laws, rues and regulaons of the Republic of the Prlippines. | authorize the agency head/authorized representative to vrtyWvalidae the contents slated herein. | ‘agree that any misepresentaion made in this document and iis attachments shal cause the filng of goverment iD asindested above, TPIT TITTY Pato= se ora coer renin WA L meer omc nose oT MEMENTO EA TTS | epee | coos nn om —— mune Jesse wremernermucron a Fameca[rstmureorcovrure umes [Psarrosunme seman jmaaer rca fo lecreucar |ronuarcs computer nsTTUTE er, fan iowa fe Fesewcar womans courvTen meme [coows wnss Tans ob TEACHER SURES fexco[wasaon fa [remanent oF aucavon es was anne oF races Ton common Tom ee ee oe cc Lena Leama, EORIAL EDUCATION A TALE faTowa CERTCATE COMPUTER aYSTENS SERVENG amas fo ERICA DUGAN A ATIONAL CERTIFICATE I ESSING psmo20 — jozsran20 ECHRNCAL EDUCATION 15D GELS ba — jee Fecweca [FECHA EDUCATION preamboeTce exman HRovonreacTon mooAARarmoAG! ewan aeons |v _‘reamaca von ore [cor eovcrora TeLensew A MAOO SORE TAO Jaco feo fecwaca ron enor Se ae feswwcar emo rane oF WANG fe ascornescic Te eames EWROWERT a Hexmeca |eoweceornvcavowur cama TOV Fou ovTecwncoweTeeswiveoara RETO |amoam re fp feowen [samo Son WESNAROVGTEASEDRNOATONSNTENEWORIALoRSS_oweze vce fr _reamvear fraRLacROMceDInSoN OF TARLAC a : ears THE ONT ROO a NORT no/ TEENA : nl omen atte coo wa wa mar 7 7 SIGNATURE DATE OF 3 Tort I