CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15244527

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 GAMAYON
FIRST NAME SHIELA
MIDDLE NAME TECSON 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS ,,

4. DATE OF BIRTH (mm/dd/yyyy) 10 / 08 / 1992
5. PLACE OF BIRTH Guinuyuran Bukidnon
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 8400
Married Separated
17. TELEPHONE NO.
Annuled Others, specify
_________ 18. PERMANENT ADDRESS Amat.,cor.Sarvida St. Brgy. Taft, SURIGAO CITY
(Capital), SURIGAO DEL NORTE
8. CITIZENDSHIP Filipino
9. HEIGHT (m) 5'2"
10. WEIGHT (kg) 57kgs ZIP CODE 8400
11. BLOOD TYPE B+ 19. TELEPHONE NO.

12. GSIS ID NO. 20. EMAIL ADDRESS (if any) shielagamayon123@gmail.com

13. PAGIBIG ID NO. 121174939478 21. CELLPHONE NO. (if any) 0948-847-4477
14. PHILHEALTH NO. 182008955906 22. AGENCY EMPLOYEE NO.

15. SSS NO. 0826487438 23. TIN

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME Gamayon

FIRST NAME Rodolfo

MIDDLE NAME Maghinay

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Tecson

FIRST NAME Letecia

MIDDLE NAME De la Nosa

III. EDUCATIONAL BACKGROUND

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

Placer West Central 2001-06- 2006-04-

ELEMENTARY 2006 1-6 Salutatorian
Elementary School 04 10

SECONDARY Placer National High School 2011 Merit Awardee

VOCATIONAL/ TRADE Surigao State College of Food and Beverage

2014
COURSE Technology Services
Bachelor of
Surigao State College of
COLLEGE Technical Teacher 2016 Graduated
Technology
Education

GRADUATE STUDIES

GAMAYON, SHIELA TECSON - T15244527 CS FORM 212 (Revised 2005), Page 1 of 4

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

LET (LICENSURE EXAMINATION FOR

80.0% 03 / 26 / 2017 Cagayan de Oro City 1543332 06/09/2017
TEACHER)

V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")

04/26/2016 Front Office Associate Lokal Suites- Pension House 7-8k 0-0 Regular No

Balanghai Hotel and Convention Absorption

02/08/2015 Front Office Associate 7-8k 0-0 No
center from OJT

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF
POSITION / NATURE OF WORK
(Write in full) HOURS
From To

STAss SSCT - Gugma alang sa Mamanwa 12 / 08 / 2017 12 / 08 / 2017 Peace Officer

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

32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

Food and Beverage Skills Training 09 / 28 / 2017 09 / 29 / 2017 20 Department of Tourism

Front Office Operations Training 04 / 21 / 2017 04 / 22 / 2017 20 Department of Tourism

The Theraphy of Knowing 03 / 28 / 2016 03 / 28 / 2016 9 Teacher Education Division

Enhancement Seminar with LET Concerns 01 / 23 / 2016 03 / 05 / 2016 64 Teacher Education Division

Teacher Education Division at

FS 7 Practice Teaching 12 / 01 / 2015 02 / 18 / 2016 270 Bacuag National Agro-Industrial
school

Education is a painful continual & Difficult work to be done in kindness, by

11 / 16 / 2015 11 / 16 / 2016 8 Teacher Education Division
watching, by warning, by praise but above all by Example

Mother Tongue Based-Multilingual & Multi-grade Education- 10 / 07 / 2015 10 / 07 / 2015 8 Teacher Education Division

Encouraging & Inspiring Good Leaders to become great through Learning

08 / 19 / 2015 08 / 19 / 2015 8
& Living

Ms. Leonilyn Malicay @ Surigao

Gender Sensitivity Training 10 / 07 / 2014 10 / 07 / 2014 8
State College of Technology

Mrs. Hayde Fabroa @ Surigao

ICT Literacy Training 09 / 13 / 2014 10 / 20 / 2014 56
State College of Technology
4th Division Infantry Philippine
Army @ Northern Mindanao
Advance ROTC Academic Phase Training (ARAPT) 05 / 16 / 2013 05 / 29 / 2013 112
School of Fisheries, Matabao
Buenavista Agusan del Norte
4th Division Infantry Philippine
Army @ Northern Mindanao
ROTC Summer Camp Traing (RSCT) 05 / 02 / 2013 05 / 15 / 2013 112
School of Fisheries, Matabao
Buenavista Agusan del Norte
4th Division Infantry Philippine
ROTC- Cadet Officer Qualifying Course (COQC) 10 / 21 / 2012 10 / 31 / 2012 88 Army @ SSCT , Magpayang,
Mainit Campus
Teacher Education Division @
FS 4 Exploring the Curriculum 19 Surigao Norte National High
School
Teacher Education Division @
FS 5 Learning Assessment Strategies 19 Surigao Norte National High
School
Teacher Education Division @
FS 6 On Becoming a Teacher 19 Surigao Norte National High
School
Teacher Education Division @
FS 2 Experiencing the Teaching Learning Process 19 Surigao Norte National High
School
Teacher Education Division @
FS 1 The Learners Development & Environment 19 Surigao Norte National High
School

GAMAYON, SHIELA TECSON - T15244527 CS FORM 212 (Revised 2005), Page 2 of 4

VII. TRAINING PROGRAMS (Start from the most recent training.)
32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

Teacher Education Division @

FS 3 Technology in the Learning Environment 19 Surigao Norte National High
School

VIII. OTHER INFORMATION

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

GAMAYON, SHIELA TECSON - T15244527 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
has immediate supervision over you in the Office, Bureau or Department where you will be If YES, give details:
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.

Dr. Cases Dotillos Dalaygon San Juan, Surigao City

Mrs. Maribel M. Catacutan Kaskag, Surigao City

Dr. Elvis P. Patulin Ocean Heights, Surigao City

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
X
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that
this information shall remain confidential. PHOTO

12664684

COMMUNITY TAX CERTIFICATE NO.

Surigao City

ISSUED AT SIGNATURE (Sign inside the box)

2017-06-05 01 / 01 / 1970

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

GAMAYON, SHIELA TECSON - T15244527 CS FORM 212 (Revised 2005), Page 4 of 4