You are on page 1of 4

CS FORM 212 (Revised 2005

)

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

I. PERSONAL INFORMATION
2. SURNAME MANALOTO

FIRST NAME HELEN

MIDDLE NAME LANZUELA 3. NAME EXTENSION (e.g. Jr., Sr.)

4. DATE OF BIRTH (mm/dd/yyyy) 10/08/1982
16. RESIDENTIAL ADDRESS 239 PUROK 2 MANGGA CACUTUD ARAYAT PAMPANGA

5. PLACE OF BIRTH OAS ALBAY
6. SEX
7. CIVIL STATUS ZIP CODE 2012
17. TELEPHONE NO. NA
18. PERMANENT ADDRESS 239 PUROK 2 MANGGA CACUTUD ARAYAT PAMPANGA

8. CITIZENSHIP FILIPINO
9. HEIGHT (m) 140 m
10. WEIGHT (kg) 50KG ZIP CODE 2012
11. BLOOD TYPE O 19. TELEPHONE NO. NA
12. GSIS ID NO. NA 20. E-MAIL ADDRESS (if any) helenmanaloto1130@gmail.com
13. PAG-IBIG ID NO. 1210-9843-6606 21. CELLPHONE NO. (if any) 09329896088/09151721518
14. PHILHEALTH NO. 07-025394347-3 4162655
22. AGENCY EMPLOYEE NO.
15. SSS NO. 34-0089079-4 23. TIN 434-230-981-000
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME MANALOTO 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAMETEODORO JR FRANCESCA L. MANALOTO 05/11/2007
MIDDLE NA MAGASPAC TRISHA ANDREA L. MANALOTO 11/30/2010
OCCUPATION NONE
EMPLOYER/BUS. NAME NA
BUSINESS ADDRESS NA
TELEPHONE NO. NA
(Continue on separate sheet if necessary)

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

SURNAME RIMBAO
FIRST NAME GABINA
MIDDLE NAME DASICO (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 BANAO, ELEMENTARY SCHOOL 1996 1990 1996

SECONDARY THE SISTERS OF MARY SCHOOL 2000 1996 2000
VOCATIONAL /

COLLEGE
TRADE COURSE BACHELOR OF SECONDARY
RIZAL TECHNOLOGICAL UNIVERSITY EDUCATION MAJOR IN 2006 2002 2006
FILIPINO

GRADUATE STUDIES
MASTER IN EDUCATION ON
BULACAN STATE UNIVERSITY MAJOR IN FILIPINO
GOING

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

Start from your current work) GOV'T SERVICE 30.00% 03/10/2013 MANUEL L. CIVIL SERVICE ELIGIBILITY 29. WORK EXPERIENCE (Include private employment. 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 EXAM FOR TEACHER(LET) 76.IV.549 11 PERMANENT YES (Continue on separate sheet if necessary) TARCILA P. 2013 (Continue on separate sheet if necessary) V. QUEZON UNIVERSTIY/MANILA 1191160 JUNE 5. JAVIER CS FORM 212 (Revised 2005).500 TEMPORARY NO PHILIPPINES 05/15/2013 PRESENT TEACHER 1 JUSTINO SEVILLA HIGH SCHOOL 18. Page 2 of 4 . 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) INTEGRATED CHEMISTS OF THE 09/01/2012 05/14/2013 OFFICE SECRETARY 9.

VI. TRAINING PROGRAMS (Start from the most recent training. SPECIAL SKILLS / HOBBIES: 34. NAME & ADDRESS OF ORGANIZATION NUMBER OF (Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK HOURS From To 05/11/2014 present Auditor/ Pananalapi IGLESIA NI CRISTO 3hrs/week (Continue on separate sheet if necessary) VII. OTHER INFORMATION MEMBERSHIP IN NON-ACADEMIC DISTINCTIONS / RECOGNITION: ASSOCIATION/ORGANIZATION 33. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY (Write in full) (mm/dd/yyyy) HOURS (Write in full) From To 03/11/2004 03/11/2004 8hrs Rizal Technological University Preparing the future Educators to be effective Teachers 07/30/2004 07/30/2004 7hrs. (Write in full) (Write in full) Samahan ng mga nagpapakadaluhasa sa Computer Literate Larangan ng Filipino NA Singing NA NA NA NA (Continue on separate sheet if necessary) CS FORM 212 (Revised 2005). Responsible Parenthood (GAD) 8hrs (Continue on separate sheet if necessary) VIII. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S INCLUSIVE DATES 31. Page 3 of 4 . Rizal Technological University Personality Development and Leadership seminar 02/23/2005 02/23/2005 Rizal Technological University Malawakang Pagsasanay pang Teatro 8hrs 12/03/2005 12/03/2005 Rizal Technological University Boosting your esteem-Empowering your Personality 8hrs 07/21/2014 07/21/2014 JUSTINO SEVILLA HIGH SHOOL School level Training on Child Protection Policy 8hrs School Inset of Social Studies and Values Education powerpoint 09/01/2014 09/01/2014 JUSTINO SEVILLA HIGH SHOOL presentation and movie maker 8hrs 10/21/2014 10/21/2014 Municipality of Arayat Pampanga Gender and Development . 35.) INCLUSIVE DATES OF ATTENDANCE 32.

and (c) Solo Parents Welfare Act of 2000 (RA 8972). please specify: ____________________ 42. CITY OF SAN FERNANDO PAMPANGA ISSUED AT SIGNATURE (Sign inside the box) 11/12/2014 07/31/2015 ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK CS FORM 212 (Revised 2005). Have you ever been formally charged? If YES. decree. give details: _______________________________ _ _______________________________ _ 40. give details: _______________________________ _ _______________________________ 38. Have you ever been guilty of any administrative offense? _ If YES. I trust that this information shall remain confidential. please specify: ____________________ b. PHOTO 29079462 COMMUNITY TAX CERTIFICATE NO. DAYRIT ATENEO DE MANILA UNIVERSITY 09266310347 DR. _ retirement. Within the third degree (for National Government Employees): appointing authority. NO. Are you related by consanguinity or affinity to any of the following : a. give details: _____________________________________ _____________________________________ _____________________________________ 37 a. FABIAN M. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. COO UNIVERSITY OF THE PHILIPPINES 09178003266 DR. AWOL or phased out. dropped from the rolls. end of term. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. give details: has immediate supervision over you in the Office. Have you ever been a candidate in a national or local election (except Barangay election)? If YES. give details: _______________________________ _ _______________________________ b. ordinance or _ regulation by any court or tribunal? If YES. please answer the following items: a. in the public or private sector? If YES. finished contract. rules and regulations of the Republic of the Philippines. ALEA DE LA SALLE UNIVERSITY 09228967825 43.36. dismissal. Are you differently abled? If YES. Bureau or Department where you will be _____________________________________ appointed? _____________________________________ _____________________________________ b. correct and complete statement pursuant to the provisions of pertinent laws. GLENN V. Have you ever been convicted of any crime or violation of any law. LILIBETH DLC. Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed? If YES. give details: _______________________________ _ _______________________________ 39. (b) Magna Carta for Disabled Persons (RA _ 7277). I declare under oath that this Personal Data Sheet has been accomplished by me. Have you ever been separated from the service in any of the following modes: resignation. DR. Page 4 of 4 . recommending authority. please specify: ____________________ c. and is a true. give details: _______________________________ _ _______________________________ 41. chief of office/bureau/department or person who If YES. Are you a solo parent? If YES. termination. Pursuant to: (a) Indigenous People's Act (RA 8371). Are you a member of any indigenous group? If YES.