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CS Form No. 212 Revised Personal Data Sheet 2 - Corrected Final
CS Form No. 212 Revised Personal Data Sheet 2 - Corrected Final
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME SAYON
NAME EXTENSION (JR., SR)
FIRST NAME MARILYN
15. AGENCY EMPLOYEE NO. 4515472 21. E-MAIL ADDRESS (if any) marilyn.sayon@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SAYON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JOANA MARIE M. SAYON
FIRST NAME DARIO 5/31/1999
OCCUPATION DRIVER
SURNAME SERRANO
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
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 /
From To
3-Day Sch Based Echo Seminar on ICT Lieracy Workshop 3/18,25/17 2/28/17 24 hrs Technical San Juan
Div. Sem Break Enhancement Seminar Workshop 10/24/16 10/27/16 16 hrs Technical SDO, Iriga
Iriga City Division Website Develpoment 10/30/15 10/31/15 16 hrs Tecnnical SDO, Iriga
Training of Gr IV Teachers on K-12 Education Program 10/5/2015 5/14/15 40 hrs Technical SDO, Iriga
Ikaanim na Pambansang Kongreso ng Wikang Pilipino sa
4/29/15 2/5/2015 40 hrs Technical
Paaralang Pribado At Pampubliko
Pambansang Seminar Workshop sa Filipino Antas Elementarya 12/2/2015 2/15/15 40 hrs Technical ng Wikang
Seminar Workshop on Stress
Free Management Towards Safe 1/15/15 1/17/15 30 hrs Technical
and Abuse Free Community
(Continue on separate sheet if necessary)
ENCODING(ICT)
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
Pambansang Kongreso
ng Wikang Pilipino
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
ICDTEA
PPSTA
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:
MARICEL L. INTIA SAN NICOLAS IRIGA CITY With full and handwritten
name tag and signature over
printed name
PEDRO N. MORADA STO. DOMINGO, IRIGA CITY
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.
ID/License/Passport No.:
Signature (Sign inside the box)
5/2/17
Date/Place of Issuance: 10/27/97
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.