Professional Documents
Culture Documents
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME JAMIL
NAME EXTENSION (JR., SR) N/A
FIRST NAME FARIDAH
9. BLOOD TYPE A
18. PERMANENT ADDRESS TUBARAN AVENUE
House/Block/Lot No. Street
15. AGENCY EMPLOYEE NO. 1040007 21. E-MAIL ADDRESS (if any) faridah_bmjamil@yahoo.com
BUSINESS ADDRESS TUBARAN AVENUE, BRGY, CURAHAB, MALABANG, LANAO DEL SUR BAI FARIDAH MACACUA JAMIL 11/2/1997
SURNAME BALINDONG
SECONDARY
VOCATIONAL / MALABANG NATIONAL HIGH SCHOOL HIGH SCHOOL 1977 1981 N/A 1981 VALEDICTORIAN
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
1/1/2017 3/14/2017 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P27,565 SG-15-1 TEMPORARY YES
7/1/2016 12/31/2016 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P26,192 SG-15-1 TEMPORARY YES
1/1/2016 6/30/2016 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P26,192 SG-15-1 TEMPORARY YES
7/1/2015 12/31/2015 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P24,887 SG-15-1 TEMPORARY YES
7/1/2014 6/30/2015 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P24,887 SG-15-1 TEMPORARY YES
7/1/2013 6/30/2014 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P24,887 SG-15-1 TEMPORARY YES
6/1/2012 6/30/2013 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P24,887 SG-15-1 TEMPORARY YES
6/1/2011 5/31/2012 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P22,688 SG-15-1 TEMPORARY YES
6/24/2010 5/31/2011 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P20,490 SG-15-1 TEMPORARY YES
7/1/2009 6/23/2010 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P18,292 SG-15-1 TEMPORARY YES
7/1/2008 6/30/2009 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P16,093 SG-15-1 TEMPORARY YES
7/1/2007 6/30/2008 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P14,630 SG-15-1 TEMPORARY YES
6/1/2007 6/30/2007 ADMINISTRATIVE OFFICER IV MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
1/1/2007 5/31/2007 ADMINISTRATIVE OFFICER II MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
1/1/2006 12/31/2006 ADMINISTRATIVE OFFICER II MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
1/1/2005 12/31/2005 ADMINISTRATIVE OFFICER II MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
1/1/2004 12/31/2004 ADMINISTRATIVE OFFICER II MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
1/1/2003 12/31/2003 ADMINISTRATIVE OFFICER II MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
12/3/2002 12/31/2002 ADMINISTRATIVE OFFICER II MALABANG NATIONAL HIGH SCHOOL P13,274 SG-15-1 TEMPORARY YES
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To
ORIENTATION WORKSHOP ON THE ENHANCED SCHOOL IMPROVEMENT PLAN 1/18/2017 1/19/2017 16 TECHNICAL
WORKSHOP ON EDUCATION IN EMERGENCY AND CONFLICT SENSITIVE EDUCATION
1/13/2017 1/14/2017 16 TECHNICAL
FOCUS ON PSYCHOSOCIAL SERVICES
SIGNATURE DATE
/ NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
CONSULTANT/ SOCIO-CIVIC
DEPARTMENT OF EDUCATION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
33. (Write in
full)
SCHOOL COMMUNITY PLANNING TEAM -
MALABANG NATIONAL HIGH SCHOOL
PARENTS TEACHERS ASSOCIATION -
MALABANG NATIONAL HIGH SCHOOL
SCHOOL GOVERNING COUNCIL -
MALABANG NATIONAL HIGH
SCHOOL
35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation YES ✘ NO
by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. 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 or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
END OF TERM
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except YES ✘ NO
Barangay election)? If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country? YES ✘ NO
If YES, give details (country):
40. 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 a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:
ROLANDO DELA ROSA MALABANG, LANAO DEL SUR N/A With full and handwritten
name tag and signature over
printed name
DR. NASSER ALIMODA MALABANG, LANAO DEL SUR N/A
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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.