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 | M | A | N | A | G | U | E | L | O | D | | | | | | | | | | | | | | J | A | N |

FIRST NAME | J | A | N | E | T | | | | | | | | | | | | | | | | | | | | | | | |

MIDDLE NAME | G | A | R | C | I | A | | | | | | | | | | | 3.| NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS
4. DATE OF BIRTH (mm/dd/yyyy) 08/02/1981
5. PLACE OF BIRTH Alicia, Isabela PADDAD, ALICIA, ISABELA
6. SEX Male Fem ale
/
7. CIVIL STATUS
Single Widowed ZIP CODE 3306
Married Separated Annulled 17. TELEPHONE NO. N/A
/
___________Others, specify18. PERMANENT ADDRESS

8. CITIZENSHIP FILIPINO PADDAD, ALICIA, ISABELA

9. HEIGHT (m) 1.58
10. WEIGHT (kg) 60 ZIP CODE 3306
11. BLOOD TYPE O 19. TELEPHONE NO. N/A
12. GSIS ID NO. 200-399-9893 20. E-MAIL ADDRESS (if any) janetmanaguelod81@yahoo.com
13. PAG-IBIG ID NO. 912-345-052-700 21. CELLPHONE NO. (if any) 09157605202
14. PHILHEALTH NO. 060-250-865-565 22. AGENCY EMPLOYEE NO. 0005318
15. SSS NO. 23. TIN 938-020-047
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME MANAGUELOD 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAMEORLANDO JR. BEA G. MANAGUELOD 08/26/2004

MIDDLE NA CASTANEDA LEA G. MANAGUELOD 0718 /2009
OCCUPATION WELDER / /
EMPLOYER/BUS. NAME N/A / /
BUSINESS ADDRESS N/A / /
TELEPHONE NO. N/A / /
(Continue on separate sheet if necessary) / /
26. FATHER'S SURNAME GARCIA / /
FIRST NAME BERNARDO / /
MIDDLE NAME LAURETA / /
27. MOTHER'S MAIDEN NAME / /
SURNAME DAMIAN / /
FIRST NAME CECILIA / /
MIDDLE NAME ROMERO ( DECEASED ) (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND YEAR

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

(if graduated)
ELEMENTARY SAN PEDRO ELEMENTARY SCHOOL ELEMENTARY 1995 GRADUATED 1989 1995 THIRD HONOR

SECONDARY PALAYAN HIGH SCHOOL HIGH SCHOOL 1999 GRADUATED 1995 1999 SALUTATORIAN
VOCATIONAL /
COMMERCIAL
SICAT- SANTIAGO CITY COOKING WITH 2013 N/A 2013 N/A
BREAD AND PASTRY
COLLEGE
TRADE COURSE BSE-SOCIAL
PHILIPINE NORMAL UNIVERSITY-IC 2003 GRADUATED 1999 2003 DIPLOMA
SCIENCE

GRADUATE STUDIES
ISABELA COLLEGES MAED 2012 36 UNITS 2011 2012

(Continue on separate sheet if necessary)

Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29. DATE OF LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE NUMBER DATE OF
CONFERMENT
RELEASE

LICENSURE EXAMINATION FOR TEACHERS 75.40% 08/31/2003 TUGUEGARAO CITY, CAGAYAN 0824737 11-14-2004

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE
30. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY GRADE
(mm/dd/yyyy) MONTHLY & STEP STATUS OF
SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To
(Yes / No)
08/01/2014 PRESENT TEACHER 3 DEPED-ALICIA NATIONAL HIGH SCHOOL 21,436 13 - 1 PERMANENT YES

06/15/2012 07/31/2014 TEACHER 1 DEPED-ALICIA NATIONAL HIGH SCHOOL 18,735 11 - 2 PERMANENT YES

06/01/2012 06/14/2012 TEACHER 1 DEPED-ALICIA NATIONAL HIGH SCHOOL 18,549 11 - 1 PERMANENT YES

06/01/2011 05/31/2012 TEACHER 1 DEPED-ALICIA NATIONAL HIGH SCHOOL 18,549 11 - 1 PERMANENT YES

06/24/2010 05/30/2011 TEACHER 1 DEPED-ALICIA NATIONAL HIGH SCHOOL 18,549 11 - 1 PERMANENT YES

06/15/2010 06/23/2010 TEACHER 1 DEPED-ALICIA NATIONAL HIGH SCHOOL 18,549 11 - 1 PERMANENT YES

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(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

N/A / / / /

/ / / /

/ / / /

/ / / /

/ / / /

(Continue on separate sheet if necessary)

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

INCLUSIVE DATES OF ATTENDANCE
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To
PHA INTERNATIONAL CONFERENCE ON HISTORICAL PHILIPPINE HISTORICAL
08/27/2015 08/29/2015
EDUCATION ASSOCIATION
ORGANIC AGRICULTURE LEARNING COURSE ON THIRD
04/11/2015 04/14/2015 ATI-RTC 02
PARTY CERTIFIED FARMS
SEASON-LONG TRAINING IN ORGANIC AGRICULTURE FOR AGRICULTURAL TRAINING
01/10/2015 04/21/2015
TEACHERS AND PARENTS INSTITUTE-RTC 02

NC II COMMERCIAL COOKING 04/01/2013 05/31/2013 TESDA

NC II BREAD AND PASTRY PRODUCTION 04/01/2013 05/31/2013 TESDA

MASS TRAINING OF FIRST YEAR TEACHERS 07/01/2010 07/04/2010 DEPED-REGIONAL OFFICE

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(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COOKING

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees): YES NO

appointing authority, recommending authority, chief of office/bureau/department or person who / details:
If YES, give
has immediate supervision over you in the Office, Bureau or Department where you will be _____________________________________
appointed? _____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where you will be appointed? /
If YES, give details:
_____________________________________
_____________________________________
_____________________________________
37 a. Have you ever been formally charged? YES NO
/
If YES, give details:
________________________________
________________________________
b. Have you ever been guilty of any administrative offense? YES NO
/
If YES, give details:
________________________________
________________________________
38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal? /
If YES, give details:
________________________________
________________________________
39. Have you ever been separated from the service in any of the following modes: resignation, YES NO
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:
________________________________
________________________________

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:

a. Are you a member of any indigenous group? YES NO

/
If YES, please specify: ____________________
b. Are you differently abled? YES NO
/
If YES, please specify: ____________________
c. Are you a solo parent? YES NO
/
If YES, please specify: ____________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

THELMA A. BALTAZAR PADDAD, ALICIA, ISABELA

ID picture taken within
the last 6 months
JOVITA E. BRILLO PADDAD, ALICIA, ISABELA 3.5 cm. X 4.5 cm
(passport size)
WILSON R. MANONGDO PADDAD, ALICIA, ISABELA
Computer generated
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and 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

25734662
COMMUNITY TAX CERTIFICATE NO.

ALICIA, ISABELA
ISSUED AT SIGNATURE (Sign inside the box)

01/23/2015
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

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