Professional Documents
Culture Documents
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I. PERSONAL INFORMATION
2. SURNAME
FIRST NAME
5. PLACE OF BIRTH
8. CITIZENSHIP
9. HEIGHT (m)
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
FIRST NAME
MIDDLE NAME
SURNAME
FIRST NAME
(if graduated)
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE
COLLEGE
COURSE
GRADUATE STUDIES
V. WORK EXPERIENCE (Include private employment. Start from your current work)
GOV'T
SERVICE
30. INCLUSIVE DATES SALARY GRADE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY & STEP STATUS OF
SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To
(Yes / No)
03/01/1981 04/30/1984 NURSING ATTENDANT PHILIPPINE MEDICAL COMMISSION 488.50 00-0 PERMANENT 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
INCLUSIVE DATES
31. NAME & ADDRESS OF ORGANIZATION NUMBER OF
(Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From To
40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
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:
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and Computer generated
or xerox copy of picture
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
Philippines.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust
that this information shall remain confidential. PHOTO