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MQCPI-QMS-GM-08-2012-001 MQCPI COMMUNITY QUALITY MANAGEMENT SYSTEM DEPARTMENT AUGUST 24, 2012 : UPDATE OF PERSONNEL PROFILE

FROM : DATE : RE

In preparation for the Regional Quality Assessment Team (RQAT) inspection for government recognition of the two programs namely Bachelor of Elementary Education (BEEd) and BS Information technology (BSIT), all are hereby requested to accomplish the following forms and forward to your respective group secretaries, on or before September 21, 2012 (Friday): GROUP Academic Group (Teaching) Academic Group (NonTeaching) Administrative Group Integral Formation Group (Non-Teaching) Integral Formation Group (Teaching) ACCOMPLISH FORM: ANNEX A Faculty Information Sheet ANNEX B Personnel Information Sheet ANNEX B Personnel Information Sheet ANNEX B Personnel Information Sheet ANNEX A Faculty Information Sheet SUBMIT TO: Ms. Joanna Penaranda Ms. Joanna Penaranda Ms. Jacquelyn N. Lozano Ms. Jenny Rose G. Mariano Ms. Jenny Rose G. Mariano

Rest assured that submitted information shall be dealt with utmost confidentiality. Thank you for your usual support.

Recommending Approval: Dr. Leticia D. Flores VPAA Approved by: Mr. Michael B. Lapid President Engr. Gregorio G. Maniti II Administrative Group Head

Rudolph D. Velasco QMS Assistant

Elizabeth V. Pusung, RGC IFG Head

Mary the Queen College (Pampanga) Inc.

Jose Abad Santos Ave. San Matias Guagua, Pampanga

Quality Management System

FACULTY INFORMATION SHEET

Kindly provide the necessary information. Do not leave any space blank. Put N/A in case information is not applicable.

PERSONAL INFORMATION Name: _________________________________________________________________________________________________ Permanent Address: ____________________________________________________________________________________________

House No. Street Barangay/Village City/Municipality Province Last Name First Name Middle Name Name Extension

Zip Code:

Employee ID No.: Level:

Assistant Instructor I Assistant Instructor Instructor Assistant Professor Professor

SSS No.: Gender:

Male Female

GSIS No: Birthday: ________

(mm/dd/yyyy)

Philhealth No.:

TIN:

Pag-Ibig No: Religion: No. of Child/children:

Civil Status:
Single Married Separated Widowed Widower

If married, name of spouse:

Place of Birth: Birthday

Name/s of Brother/s or Sister/s

Civil Status

Educational Attainment

School Last Attended/ Graduated

Occupation and Company Affiliated

(Add an attachment and mark A if additional space is needed)

Name/s of Child/ Children

Birthday

Civil Status

Educational Attainment

School Last Attended/Graduated

Occupation and Company Affiliated

(Add an attachment and mark B if additional space is needed)

OTHER INFORMATION
Computer Knowledge/Skills: Special Skills/Hobbies:

CONTACT INFORMATION Mobile No.: ___________________ Tel. No __________________

Business No.: __________________ Contact No:

Fax No.: _____________

Email Address: ____________________

Person to Notify in case of Emergency: EMPLOYMENT INFORMATION Employment Status: Full Time Part Time Previous Employment: Position

Relationship:

Address:

If full time, indicate whether:

REGULAR PROBATIONARY CONTRACTUAL

No. of Work Hours per week:

Term of Appointment:

Annual Salary:

Term of Employment

Organization

(Add an attachment and mark C if additional space is needed)

Primary Teaching Discipline:

Subjects Taught:

Work Schedule: (Day and Time)

(Add an attachment and mark D if additional space is needed)

(Add an attachment and mark E if additional space is needed)

PROFESSIONAL RECORD Educational Qualifications Degree School attended/graduated

If in progress No of Units earned

Year Graduated

With thesis/ Dissertation writing? (Yes/No)

Baccalaureate

Masters

Doctorate

Special Training Course

Membership in Professional Organization Association ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ Declaration of Dependents

Position/Title _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ TAX SSS

Years of Membership _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ Pag-Ibig Others (Pls. Specify)

PhilHealth

Dependents Name

Age

Relationship

(Put an x under each item wherein the dependent is declared)

I certify that the above information is true and correct: ________________________

Mary the Queen College (Pampanga) Inc.

Jose Abad Santos Ave. San Matias Guagua, Pampanga

PERSONNEL INFORMATION SHEET

Kindly provide the necessary information. Do not leave any space blank. Put N/A in case that information is not applicable.

Quality Management System

PERSONAL INFORMATION Name: _________________________________________________________________________________________________

Last Name First Name Middle Name

Permanent Address: ___________________________________________________________________________________________

House No.

Zip Code:

Employee ID: Level: Supervisor Rank and File Consultant

Street

SSS No.:

Barangay/Village

GSIS No: Civil Status:

Single Married Separated Widowed Widower

Philhealth No.:

City/Municipality

TIN:

Province

Pag-Ibig No: Religion: No. of Child/children:

Gender:
Male Female

Birthday: ________
(mm/dd/yyyy)

If married, name of spouse:

Place of Birth: Birthday

Name/s of Brother/s or Sister/s

Civil Status

Educational Attainment

School Last Attended/Graduated

Occupation and Company Affiliated

(Add an attachment and mark A if additional space is needed)

Name/s of Child/ Children

Birthday

Civil Status

Educational Attainment

School Last Attended/Graduated

Occupation and Company Affiliated

(Add an attachment and mark B if additional space is needed)

OTHER INFORMATION
Computer Knowledge/Skills: Special Skills/Hobbies:

CONTACT INFORMATION Mobile No.: ___________________ Tel. No __________________ Business No.: __________________ Fax No.: _____________ Email Address: ____________________

Person to Notify in case of Emergency: EMPLOYMENT INFORMATION Employment Status: Full Time Part Time Previous Employment: Position

Relationship:

Contact No:

Address:

If full time, indicate whether:

REGULAR PROBATIONARY CONTRACTUAL

No. of Work Hours per week:

Term of Appointment:

Annual Salary:

Term of Employment

Organization

(Add an attachment and mark C if additional space is needed)

Primary Teaching Discipline:

Subjects Taught:

Work Schedule: (Day and Time)

(Add an attachment and mark D if additional space is needed)

(Add an attachment and mark E if additional space is needed)

PROFESSIONAL RECORD Educational Qualifications Degree School attended/graduated

If in progress No of Units earned

Year Graduated

With thesis/ Dissertation writing? (Yes/No)

Baccalaureate

Masters

Doctorate

Special Training Course

Association ______________________________________ ______________________________________ ______________________________________ Declaration of Dependents Dependents Name Age

Position/Title ______________________________ ______________________________ ______________________________ TAX SSS

Years of Membership ______________________________ ______________________________ ______________________________ PhilHealth Pag-Ibig Others (Pls. Specify)

Relationship

(Put an x under each item wherein the dependent is declared)

I certify that the above information is true and correct: _______________________