Professional Documents
Culture Documents
PDS MaELA
PDS MaELA
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME BARBA
NAME EXTENSION (JR., SR
FIRST NAME MAELA
MIDDLE NAME MAGNO
3. DATE OF BIRTH
(mm/dd/yyyy) FEB.08,1994 ✘ Filipino Dual Citizenship
by birth b
4. PLACE OF BIRTH MALATE,MANILA If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female
Other/s:
SAPAN
Subdivision/Village Ba
7. HEIGHT (m) 160cm SAN ANDRES CATAN
City/Municipality Pr
8. WEIGHT (kg) 75kgs. ZIP CODE 4801
9. BLOOD TYPE O+
18. PERMANENT ADDRESS 019
House/Block/Lot No. S
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) N/A
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME N/A
MIDDLE NAME
OCCUPATION
SURNAME MAGNO
FIRST NAME MITZIE
MIDDLE NAME PANTI (Continue on separate sheet if necessary
BACHELOR OF SCIENCE IN
NAGA COLLEGE FOUNDATION 2015 2017 N/A
MIDWIFERY
BACHELOR OF SCIENCE IN
CATANDUANES COLLEGES 2018 2018 N/A
SECONDARY EDUCATION
GRADUATE STUDIES .
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM
L DATA SHEET
rience Sheet shall cause the filing of administrative/criminal case/s against the person
Dual Citizenship
by naturalization
Pls. indicate country:
Street
SAPANG PALAY
Barangay
CATANDUANES
Province
4801
Street
SAPANG PALAY
Barangay
CATANDUANES
Province
4801
N/A
09059704518
N/A
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
2006
2010 N/A
N/A N/A
2012 N/A
2017 N/A
2017 N/A
SIGNATURE DATE
CS FORM 2
LICENSE (if applicable)
NUMBER Date of
Validity
162809 FEB.8,2021
STATUS OF
APPOINTMENT
(Y/ N)
CONTRACTUAL Y
CONTRACTUAL N
CONTRACTUAL Y
ue on separate sheet if necessary)
8-DAYS BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE (BEmONC) & ESSENTIAL
9/11/2015 11/16/2015 BICOL MEDIC
INTRAPARTUM AND NEWBORN CARE COURSE FOR MIDWIVES
NAGA COLLE
FAMILY PLANNING COMPETENCY FPCBT LEVEL 1 7/12/2015 11/12/2015
LYING IN CLIN
NAGA COLLE
FAMILY PLANNING COMPETENCY FPCBT LEVEL 2 12/12/2015 12/16/2015
LYING IN CLIN
NAGA COLLE
"USAPAN'' FACILITATORS TRAINING (CONVERSATION SERIES) 7/1/2016 11/1/2016
LYING IN CLIN
45 HOURS BASIC CALL CENTER TRAINING COURSE (BPO) 2/5/2016 5/17/2016 NAGA COLLE
NAGA COLLE
20 HOURS LACTATION MANAGEMENT TRAINING 06/29/2016 1/7/2016
LYING IN CLIN
SKILLS MANAGEMENT TRAINING ON ACCESSING GRANTS ON FOREIGN GOVERNMENT
1/3/2017 3/3/2017 NAGA COLLE
FOR LOCAL DEVELOPMENT PROJECTS
NAGA COLLE
EMEGENCY FIRST AID AND BLS/CPR FOR LAY RESCUE 03/23/2017 03/24/2017
CALABANGG
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
eparate sheet if necessary)
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘
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? ________________________________
________________________________
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:
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.