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Faura - Personal View` ^C1 C2 oC3 RC4WLookup!  ;   ;4 P6 Z_969B47C9_E527_4846_B895_CFB9BE0B9D06_.wvu.FilterData; O5 Z_969B47C9_E527_4846_B895_CFB9BE0B9D06_.wvu.PrintArea;4 O5 Z_969B47C9_E527_4846_B895_CFB9BE0B9D06_.wvu.PrintArea;J0 Z_969B47C9_E527_4846_B895_CFB9BE0B9D06_.wvu.Rows=&&8p4 i 3  @@N%PERSONAL DATA SHEETSURNAME FIRST NAME MIDDLE NAME2.SEX4. CIVIL STATUS5.7.8.9.11.PLACE OF BIRTH HEIGHT (m)13. WEIGHT (kg)ADDRESS15. BLOOD TYPE CITIZENSHIP6.14. OCCUPATIONBUSINESS ADDRESS24.II. FAMILY BACKGROUNDIII. EDUCATIONAL BACKGROUNDLEVEL ELEMENTARY SECONDARYGRADUATE STUDIES FromToRATING29.NUMBER OF HOURS30.31.32.33.34.36.ZHave you ever been a candidate in a national or local election (except Barangay election)?38.39. TELEPHONE NO.IV. CIVIL SERVICE ELIGIBILITYNAMEINCLUSIVE DATES (mm/dd/yyyy)EMPLOYER/BUS. NAMESPECIAL SKILLS / HOBBIES:POSITION TITLE (Write in full)I. PERSONAL INFORMATIONVIII. OTHER INFORMATIONPOSITION / NATURE OF WORK_VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S40.41.LICENSE (if applicable)? CONDUCTED/ SPONSORED BY (Write in full)Yes/NoYesNoCstatSingleMarried SeparatedWidowedGenderMaleFemaleINCLUSIVE DATES OF ATTENDANCEVOCATIONAL / TRADE COURSEPAG-IBIG ID NO.PHILHEALTH NO.BCAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEEMONTHLY SALARYSTATUS OF APPOINTMENT 1. CS ID No.OV. WORK EXPERIENCE (Include private employment. Start from your current work)-SALARY GRADE & STEP INCREMENT (Format "00-0") Page 1 of 4)(Continue on separate sheet if necessary)UREFERENCES (Person not related by consanguinity or affinity to applicant / appointee) 10.12.35.3742.43.COMMUNITY TAX CERTIFICATE NO. ISSUED ATISSUED ON (mm/dd/yyyy)DATE ACCOMPLISHEDSIGNATURE (Sign inside the box)  RIGHT THUMBMARK FIRST NAME MIDDLE NAME / / | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | GSIS ID NO.|Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?COLLEGE>VII. TRAINING PROGRAMS (Start from the most recent training.)FATHER'S SURNAME27. 28.SPOUSE'S SURNAMEPHOTO%SCHOLARSHIP/ ACADEMIC HONORS RECEIVEDDATE OF BIRTH (mm/dd/yyyy)TEL. NO.DDEGREE COURSE (Write in full) 16. RESIDENTIAL ADDRESS17. TELEPHONE NO.18. PERMANENT ADDRESS19. TELEPHONE NO.20. E-MAIL ADDRESS (if any)21. CELLPHONE NO. (if any)22. AGENCY EMPLOYEE NO.23. TIN ZIP CODE 'a. Have you ever been formally charged?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:I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential.a.b.)Are you a member of any indigenous group?a. Are you differently abled?b. Are you a solo parent?c. SSS NO.MOTHER'S MAIDEN NAME26. ;b. Have you ever been guilty of any administrative offense?Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?If YES, give details: _____________________________________ _____________________________________ _____________________________________If YES, give details: _____________________________________ _____________________________________ _____________________________________XIf YES, give details: ________________________________ ________________________________,If YES, please specify: ____________________(to be filled up by CSC) / / / / / / / /GAre you related by consanguinity or affinity to any of the following : NON-ACADEMIC DISTINCTIONS / RECOGNITION: (Write in full)MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)BTITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full)INCLUSIVE DATES (mm/dd/yyyy)INCLUSIVE DATES OF ATTENDANCE (mm/dd/yyyy)NAME & ADDRESS OF ORGANIZATION (Write in full)(CS FORM 212 (Revised 2005), Page 4 of 4( CS FORM 212 (Revised 2005), Page 3 of 4'CS FORM 212 (Revised 2005), Page 2 of 4CS FORM 212 (Revised 2005)125. NAME OF CHILD (Write full name and list all)!PLACE OF EXAMINATION / CONFERMENTNUMBERDATE OF RELEASENAME OF SCHOOL (Write in full)WHIGHEST GRADE/ LEVEL/ UNITS EARNED (if not graduated)GOV'T SERVICE (Yes / No) DATE OF EXAMINATION / CONFERMENTHave you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the rolls, dismissal, termination, end of term, finished contract, AWOL or phased out, in the public or private sector?3Within the third degree (for National Government Employees): appointing authority, recommending authority, chief of office/bureau/department or person who has immediate supervision over you in the Office, Bureau or Department where you will be appointed?I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.!3. 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