Professional Documents
Culture Documents
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME BULAGNIR
15. AGENCY EMPLOYEE NO. 6291558 21. E-MAIL ADDRESS (if any) genward.bulagnir@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME NONE 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) NONE
FIRST NAME NONE
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
SURNAME LAMUSAO
ELEMENTARY CATUBIG CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 6/4/2004 3/31/2006 GRADUATE 2006 NONE
VOCATIONAL
SECONDARY / CATUBIG VALLEY NATIONAL HIGH SCHOOL HIGH SCHOOL 6/5/2006 4/5/2010 GRADUATE 2010 NONE
FAIR GEMS ACADEMY COMPUTER HARDWARE SERVICING 8/10/2015 ### 6 UNITS 2015 NONE
TRADE
COURSE UNIVERSITY OF EASTERN PHILIPPINES, PEDRO
COLLEGE
REBADULLA MEMORIAL CAMPUS CATUBIG
BACHELOR OF SECONDARY EDUCATION 6/7/2010 3/31/2014 GRADUATE 2014 NONE
REGIONAL DIVISION-BASED TRAINING IN COACHING AND OFFICIATIING 9/3/2017 11/5/2017 24.0 DEPED CATBALOGAN CITY DIVISION
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
a. Have you ever been found guilty of any administrative offense? YES ✘ NO
35.
b. Have you resigned from the government service during the three (3)-month period before the last
election to promote/actively campaign for a national or local candidate? YES If YES, give details:
✘ NO
39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):
40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA YES ✘ NO
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 a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:
PEPITO ADARAYAN CATUBIG, NORTHERN SAMAR 9262159221 With full and handwritten
name tag and signature over
printed name
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein.
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.