CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME FIRST NAME MIDDLE NAME 4. DATE OF BIRTH (mm/dd/yyyy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS

BATALAO DEXTER GAYAWET 09/22/1985 Tuguegarao City, Cagayan Male Female

Single Married Annulled Widowed Separated Others, specify ___________
ZIP CODE 17. TELEPHONE NO. 18. PERMANENT ADDRESS 16. RESIDENTIAL ADDRESS 3. NAME EXTENSION (e.g. Jr., Sr.)

No. 345, Purok 7, Interior New Lucban, Baguio City, Benguet

2600 N/A

8. CITIZENSHIP 9. HEIGHT (m) 10. WEIGHT (kg) 11. BLOOD TYPE 12. GSIS ID NO. 13. PAG-IBIG ID NO. 14. PHILHEALTH NO. 15. SSS NO.

Filipino 1.8 m 70 kgs. "o" N/A 1210 1795 1385 N/A 01 1847988 2
19. TELEPHONE NO. 20. E-MAIL ADDRESS (if any) 21. CELLPHONE NO. (if any) 22. AGENCY EMPLOYEE NO. 23. TIN ZIP CODE

Purok 2, Bulanao Norte, Tabuk City, Kalinga

3800 N/A redxet_125@yahoo.com 0999-999-8696 N/A N/A

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUS. NAME BUSINESS ADDRESS TELEPHONE NO.

N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

25. NAME OF CHILD (Write full name and list all)

DATE OF BIRTH (mm/dd/yyyy)

/ / / / / / / / / / /

/ / / / / / / / / / / / /

26. FATHER'S SURNAME FIRST NAME MIDDLE NAME 27. MOTHER'S MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME

BATALAO EUGENE MASSAGAN

GAYAWET CORAZON BATALAO (Continue on separate sheet if necessary)

/ /

III. EDUCATIONAL BACKGROUND

28. LEVEL NAME OF SCHOOL (Write in full) DEGREE COURSE (Write in full) YEAR GRADUATED HIGHEST GRADE/ LEVEL/ UNITS EARNED (if not graduated) INCLUSIVE DATES OF ATTENDANCE From To SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

(if graduated)

ELEMENTARY SECONDARY VOCATIONAL / TRADE COURSE COLLEGE

BULANAO CENTRAL SCHOOL KALINGA ACADEMY

ELEMENTARY HIGH SCHOOL

1998 2004

Graduated Graduated

1992 2003

1998 2004

With Honors With Honors

UNIVERSITY OF BAGUIO

Bachelor of Arts Major in Political Science

2010

Graduated

2008

2010

Dean's Lister

GRADUATE STUDIES

(Continue on separate sheet if necessary) Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

29. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE RATING DATE OF EXAMINATION / CONFERMENT LICENSE (if applicable) PLACE OF EXAMINATION / CONFERMENT NUMBER DATE OF RELEASE

CAREER SERVICE PROFESSIONAL ELIGIBILITY

80.52%

07/27/2008

BAGUIO CITY

9/29/2008

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. INCLUSIVE DATES (mm/dd/yyyy) From To POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)
MONTHLY SALARY
SALARY GRADE & STEP INCREMENT (Format "00-0")

STATUS OF APPOINTMENT

GOV'T SERVICE (Yes / No)

09/24/2012

To date.

COMPUTER MAINTENANCE TECHNOLOGIST II LEGAL AIDE

Department of Public Works and Highways Kalinga District Engineering Office Department of Public Works and Highways P320.13/day Regional Office, CAR House of Representatives - Lone District of Kalinga, Congressional District Office House of Representatives - Lone District of Kalinga, Congressional District Office P8,000.00/Mo. Honorarium P8,000.00/Mo. Honorarium

SG-15

PERMANENT

Yes

11/22/2010

06/01/2012

JOB ORDER

Yes

03/02/2009

03/31/2010

SCHOLARSHIP LIAISON

CASUAL

Yes

09/08/2008

02/27/2009

LEGISLATIVE STAFF

CASUAL

Yes

04/16/2008

06/30/2008

MESSENGER

Department of Public Works and Highways P272.00/day Kalinga District Engineering Office House of Representatives - Lone District of Kalinga, Congressional District Office P6,000.00/Mo. Honorariuum

JOB ORDER

Yes

08/01/2007 / / / / / / / / / / / / / / / / / / / / / / / / / / / /

01/11/2008 / / / / / / / / / / / / / / / / / / / / / / / / / / / /

RECORD OFFICER

CASUAL

Yes

(Continue on separate sheet if necessary) CS FORM 212 (Revised 2005), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31. NAME & ADDRESS OF ORGANIZATION (Write in full) INCLUSIVE DATES (mm/dd/yyyy) From To NUMBER OF HOURS POSITION / NATURE OF WORK

Pasil Student Organization (Tabuk Chapter)

06/16/2008 / / / / / / / /

06/01/2009 / / / / / / / /

Chapter President

(Continue on separate sheet if necessary)

VII. TRAINING PROGRAMS (Start from the most recent training.)

32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full) INCLUSIVE DATES OF ATTENDANCE (mm/dd/yyyy) From To NUMBER OF HOURS CONDUCTED/ SPONSORED BY in full) (Write

Seminar on Asian Parliamentary Debate Format

09/17/2010

09/17/2010 09/19/2009

8 8

Seminar on Asian Parliamentary Debate Format - 2009 Academic 09/19/2009 Olympics Industry Clustering and Value Chain Assesment Workshop for Kalinga Coffee and Organic Rice

04/28/2009

04/30/2009

28

University of Baguio - Office of Student Affairs University of Baguio - Office of Student Affairs and in coordination with the Soapbox Union Philippine Development Assistance Progamme Inc. and House of Representatives - Congressional District Office, Kalinga

/ / / / / / / / / / / /

/ / / / / / / / / / / /

/ / / / / / / / / / / /

/ / / / / / / / / / / /

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

33. SPECIAL SKILLS / HOBBIES: 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: (Write in full) 35. MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)

DRIVING

Certificate of Recognition: " Mr. LAGA 2008". For winning in the 2008 LAGA FASHION SHOW during the 2008 Kalinga Day Celebration. Awarded by the Office of the Governor Province of Kalinga.

PASIL STUDENT ORGANIZATION (P.S.O.TABUK CHAPTER) KALINGA-APAYAO STUDENT ASSOCIATION (BAGUIO) POLITICAL SCIENCE STUDENT ASSOCIATION (U.B.-POLITIS) PASIL STUDENT ORGANIZATION (BAGUIO-BENGUET CHAPTER) KALINGA LAW STUDENT ASSN. (BAGUIO-BENGUET CHAPTER)

READING TYPING BASIC COMPUTER OPERATION BASIC AUTOMOTIVE TROUBLESHOOTING

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4

36. a.

Are you related by consanguinity or affinity to any of the following : Within 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?
YES NO If YES, give details: _____________________________________ _____________________________________ _____________________________________

b.

Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?

YES NO If YES, give details: _____________________________________ _____________________________________ _____________________________________ YES NO If YES, give details: ________________________________ ________________________________ YES NO If YES, give details: ________________________________ ________________________________ YES NO If YES, give details: ________________________________ ________________________________ YES NO

37

a. Have you ever been formally charged?

b. Have you ever been guilty of any administrative offense?

38.

Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?

39.

Have 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?

If YES, give details: ________________________________ ________________________________

YES NO

40.

Have you ever been a candidate in a national or local election (except Barangay election)?

If YES, give details: ________________________________ ________________________________

41.

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: Are you a member of any indigenous group? Are you differently abled? Are you a solo parent?
YES NO If YES, please specify: KALINGA YES NO If YES, please specify: ____________________ YES NO If YES, please specify: ____________________

a. b. c.

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO.

GARY U. DAMIAN SAMUEL BAYANGAN

Purok 2, Bulanao Norte, Tabuk City, Kalinga Dagupan Centro, Tabuk City, Kalinga

0927-871-4192 0916-771-8099

ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size)

43.

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. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential. 33404331
COMMUNITY TAX CERTIFICATE NO.

Computer generated or xerox copy of picture is not acceptable

PHOTO

BAGUIO CITY
ISSUED AT SIGNATURE (Sign inside the box)

06/01/2011
ISSUED ON (mm/dd/yyyy)

06/06/2011
DATE ACCOMPLISHED RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4