‘Are you related by consanguinily or affiniy to the appointing or recommending authority, oF to the chief of urea or ofcec othe porson who has iamedile supervision over youn the Oe, ‘Bureau or Department where you will be appointed, «within the third degree? Ove ». within the fourth dogree (fox Local Goverment Unit -Carosr Employees)? ves IFYES, give deta: Have you ever bon oan gly of ey atric Oe? Ove No IFYES, give details ». Have you been criminally charged before any cout? Oves No IFYES, give deta: Date File Status of Casal: 38 Have you ever bon canted of ay me or vidalon of any aw, dre, rananca&eOeIOTDY| yes a any cout o buna? YES, Ge dle ‘Have you ever been cepareed fom the servos in ey ofthe folowing modes: rsignalon, YS Dw ‘elrement, dropped from the rls, ismissa, termination, end of en, fished contractor phased out] IF YES, give detls (bolion in the public or private sect’? nalon om orev {8 Have you aver boon a candidat in a alonal or lee Seoon Fld wit bo lat year (scent Tp veg NO Barangay election)? IFYES, give deal ». Have you resigned ftom the government service during the the (3}-nonth period before thelast | YES No lection to promoteactvely campaign for a national ot local candida? IFES, give deal 8, Have you aoguited te elalus of an immigrant or parmaneni resident of another country? Ove No EYES, give det (county): "2 Puravant to: (a) Indigenous People's Act (RA B31), (6) Nagna Carta for Disabled Pereone (RA 72TT; and () Solo Parents Welle Act of 2000 (RA 6972), please answer the flloning tems: }= Are you a member of any indigenous group? Ovs No IVES, please spocity > Are you a person with dictilty? O ves 0. : If YES, please speciy ID No: Je Ave you a solo parent? Oves Gro YES, please speciy 1D No: {1 REFERENCES Personnes consangin ytaptcs aparie) NaN AOORESS TELNO, ‘SAN VICENTE, CITY OF SAN IR. RAUL CA’ AN GATAN PEGUARDG LA Nac 0920.9635173 ‘SAN VICENTE, CITY OF SAN MS. ENGRACIA GATAN Eh aso aon 0988-9579010 SAN iCHTY OF SAN MR, VERGILIO SESE TEENANDO. 7B [dedare underoath tat Ihave poteoraly accomplished fis Pereonel Dela Sheet which is arue, ooredt and comple slatement pursuant to-the provisions of petnent laus, rules end requations of the Republic of the Prppines. | authorize the agency head / authorized representative to veriyvdale the conents slated herein. | epree that ary rrisrepresertation meade inthis document and its alachments shal cause the fing of edinistveeiinal against me. [Boveranen ated tarrant ona ss ac navn oc) JPLEASE INDICATE ID Number and Cat of suarce [conmmentisuet 0° UMD (S58) JoucerePaspotN: ORK: oft 7en0165 Perec ea or SUBSCRIBED AND SWORN tobefore ms ths _2tant exiting hisher vid issued goverment 'D as indicted sbove, Spans Sp rae taba Person Adninistrng Oath ‘CS FORUZ2 Revmos OTT) Paget[rst caleatatn eau Men dhs hciia nc aai ta tees a tcoeco oe (Wa) ban ves POSITION / NATURE OF WORK. es : i NA NA NA NA NA a mena a t ANG ARO DEVELOPMENT INTERVENTIONSITRAIING PROGRAMS. ATTENDANCE ane o ‘CONDUCTELY SPONSORED BY ene a rom | donor Semen een) == NA | 4 | | T | | | | | | T | EI + 7 NONMCADB OSTACTIONS RECON MEERA WASSOOATONRGANZATON ton seus netonBes 2 ‘susan, = Waa) COOKING Nia NA Eaiaeomairmarsaear F202 2, PagoCAREER SERVE RA 088 OARD BAD) OER rea UWS SES CSE ACEO XAUNATONCONFERIENT {AFG ELOBLTY ORVERS LUCENE NA NA WA NA NA WA rT, [Ein or a ea RE INELUSNE OATES ar ett reemon me erwmueraccrcvioreticoummy | vernay | oHOHH | surusor | Sue {Wit De at brevet) {Wo 0 AOD at abbr) SAR | SFomarney | APPONTUENT: | Oy fon 6 ‘en 2010 2020 [CASHIER |PC GATSON SERVICES INC 6,500.00 N 3 ams | 2010 [coox [Po GATSON SERVICESING 4000.00 N 100s | 1800 Raper cudfer NAKATI PRINTING PRESS 2800.00 N 1998, voor [HOKE Keeping CENTURY TUNA 4,500.00 N —“ro you relied by consanguinity oF afriy tothe appointing or recommending autho, of the chief of bureau o ffe or othe person who has immediate supervision over you inthe Offce, ‘Bureau o Department where you wil be epppcinied, within he tired dogs? Ove no b. win the fourth degre (fr Local Govenmant Unit - Career Employees)? Os No IFYES, give deta: “Have you over boon found gully of any adminsraveoflense? Ow IVES, give deta: 'b, Have you been criminally charged before any court? O ves NO IFYES, giv deta: Dale Fie Salus of Cal: =e. Have you ever bean confcied of any aie or vcalon of ny law, decree, orénance or regulon By] yes 1% ay cont anne! IFYES, give deta: {lave you ever been separated om the sence in any of he folowing modes: reignaion, relrement, dropped ftom the ol, dismissal, termination, end of tam, fished contractor phased oul YES, give dota: (abolition) in the pubic or prvae sector? Resign om ocovious amount —__ “A_& Have you ever been a candidala in analonal or local elecion held wihin the asl year (except | yes NO. Barangay election)? IYES, give details ». Have you resigned from the government sevice curing the treo (3} month period beer tholast |) vES leon to promateactvly campaign fr anationlarlocel candidate? IVES, give deta: Gp. Hlave you acquired he slalus ofan migrant or parmanent resident of another eouny? ow IFYES, give details (county): Prsuant io a) Indigenous People's Ae (RA 8371, () Magna Cait for Disabled Persons [RA 7277}; ad () Solo Parents Welfare Act of 2000 (RA 8972), pleese answer the faloing items: 1s Are you a member of any indigenous group? > Are you apeson with isabiiy? J. Are you a solo parent? 41, REFERENCES Pon notte crsanguny sity epicentre) Oo ves No If YES, please speciy O ves No I YES, please speci ID No: 0 no IF YES, please specify ID No: Nae HOORESS| TNO. JPARIAN, CITY OF SAN FERNANDO, LA ‘hed ere” MR. PHILIP CASTANEDA lwo . jeice (Gosport se) ISANTIAGO NORTE, CITY OF SAN MS. GLORINA AQUINO |FERNANDO, LA UNION Wtf and han name tag ad signature er [SANTIAGO NORTE, CITY OF SAN MS. ARLYN DOMIS-AG |FERNANDO, LA UNION ageinst me. [Goverment essed 10 paPeaya oss 85m Drs en) PLEASE INDICATE 10 Number and Date of ssuanco Goverment sue: DRWERSLICENSE "ET daclaro undar oan thal have personaly accomplished this Perconal Data Sheet which ave, corect and comple satement pursuant to the provisions of patient laws, rules and regulaions ofthe Republic ofthe Philippines, | authorize the agenoy head / authorized representaive to verifyvalidale the contens sated herein. | agree that a rrisrepresentation mado in this document and its etachments shall cause the fling of adminitratvetiminl cases ied rae Comper generated cr potocopeg pete (Brot aeepable ‘SUBSCRIBED AND SWORN to befor me this font exbitng hier vali issued goverment IO as ndcated above Person Administering Oath ‘COFORUZT2 evans 2017) PagetPERSONAL DATA SHEET arvana: Any msrepresntaon made Inthe Persona Data Sheet andthe Work Experience Sheo shal cause tha Ming of adminiraeteriminal cas agaist the parson concemed. |neaD rHe ATTACHED GUIDE TO FLLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM. DONOT ABBREVIATE. Domine Foticmany RT woo. ocr beats Fanaa ‘29880 a oC ono Ddyoitn OC) by naturatzation “Puce anne NEGROS OCODENTAL ied dat Pl. at cent 5 SEX O Mate D Female ne wT, conan Sige Th werred [17 RESDENTI DRESS ZONES Ol Widowed DD Separated Se D er EAR AGUETIN esi 7a te EOF Sa ER TAO co) ® Pome 2it0 # accor » a aR a FOIE abe Si 5 38.080 WA WA SANAGUSTIN 11 PAGING 1D NO. 1212-7088-0735 }- ae a error saree ———— te} 2 PRUEATANO WA recone 210 1 eN0 [erases a wa t parma, N33 SOIR BHU CLO fr wae 452151574 094s 159766 sxocranoeo | WA ranelpulido@gmaicom fa srowsessumae fs nat CEN th mame reccus sane FIRST MANE eee APR&LDOCTO PULIDO 12612005 one nae | ‘anon wa BmLoeRmisesswee | WA BISRESS ADRESS WA TEERONEND WA he FaveRS aN DocTo RST NE ROLANDO [receresence sy WA Moo we ‘a0cs0n PP mrersinoonne t 1 sume [ | ease | L T ‘name e [BASIC EDUCATIONDEGREEICOURSE HGHEST LEVEL aie —_— a ‘viet warsexe> | auscmeo| ‘eno Fos. To — evencant -PARANG ELEMENTARY SCHOOL ELEMENTARY eee | 1092 | orapuaveo| ee | wa | sect PARANG NATIONAL He ScH00L vt scHooL, tom | sem | orouarea | te0s | wa Taare NA wa |wa | wa | WA wa | ows | | 1 cousce wa wa wa ]oua | ow | wa tom | 1 cuoure snes wa WA we [im | im | wa | ma [ee] ener |Cece Ue ee eee PosmoU MATuRE Wome NA \Vi. LEARNING AND DEVELOPMENT (LD) NTERVENTIONS/TRAINING PROGRAMS ATTENDED eienadnennnatet tether ate ee ea) ONTESOF TL FLEA Ao DEL OPVENT NTERVENTERS RANG RECRANS ATOONCE (vee ‘emis NA Peon oun ovacacec sTNCTONSRECOGITICN sq NOISERSHE MASSCCATENDRANAATION (iat) (vet NA WA7 CAREER SERVCETRA OM (BOAROLBARY AER | panyyg DATE OF ENS ai) SPECIAL LAWA/CES/CAEE i ExAUNATIN? LACE OF EXINATION/CONFERMENT Da BARANGAY EUGIBLITY OVERS UCENSE (wrested | conrerwent aween | Vey NA NA NA NA NA NA non parte TrvesaTy Inoue Dares sas a emis) PosTONTE oeparmuentracencyiornicerconpaiy | womer | cH] sunsor | oO (titein it et tee (itn tb ot br) sunt | Femttoay | MPoNne | Tip Fen 1 ‘ome aor | oxzo20 |WATRESS PATIO DEL SOL SEAFOOD RESTAURANT | 6,000.00 N air | 2017 |SALEsLAy [SKIN MAGICAL 5500.00 N zoe | 2016 |cASHIER |KUBONG SAWALI 6,500.00 N 207 | 2009 KITCHEN HELPER [Pc GATSON SERVICES INC 1,000.00 oncalt | oN 2005 | 2007 |UNBRELLA GIRL [THUNDERBIRD RESORT 4,500.00 oncal | oN [seme [ig owe] =i mrmmmnene[Se ee ee Ba PERSONAL DATA SHEET J'ARMING: Any mlsropresantaon made in the Personal Date Sheet andthe Work Experience Shoot hallcusethe lng of acmlevatvatriminl case gens the parson concerned. eto mi arracten une ro reine OUT HE PEEOHAL DATA SHEET PD) BEFORE ACCOMPLHIG THES se ep shat cen Indes NA nc appeabe, DO NOT ABBREVATE. Ted RERTEROTA a FAST NE REYHALYN one NE PULIDO TINEOr ERT es orr1889 fs omzensse Fito) Dual ctzensip CDbytith Cy natratzaton 4 PUCE CE BRT ‘SANFERNANDO, LA UNION tobe cto, 5 sex Oi mae © Ferate pink te v ow status i Sexi TH wed [17 RESIDENTIAL ADDRESS ‘SICUTAN ROAD 1D weones Di separtes Bi ones 7 HT fa 153 | 8 NECA ol 5 ze cooe 8 e000 TE A fs Pemannen anoness : io esis NA 5 i. pactaciono 9191-93120642 m 2 PHUMEALTAND NA ze coe ts sno. on2ossese.s| fis ree no WA ha rnin 459576771 fo wate wo onas.seozte2 is aczncy EWRLOTEE NO WA eawooness tm | input @ana.cm fv OREN te ae OME OF BR mts ste ry FRETS LTBI avOREWP-OANGEL ‘owes woot wwe wa JOHN. DANGEL cara oomiraian WA exnovevausnessiaie | WA | nes ORES WA TaEROEN WA be FaTERSeuMWE PuuDo ae = fmcoraaona oy WA Monee SANTOS fs worreRs wanennave sme aos ] esr ae RZALINA move Facial eres se casedcadscocUe weer sc vocrornowscecouse | renermoonc [RET a core ste | en S| a Z From wo vee RECEVED ia ASOT ERERTIRT ESOL eso REUSE S00. | eeu von | awe [amore] wm [wn eae LAUNON ONL HH EEL won 100, wom | aw onousreo| ww | wa aa vos "a wm “f=, | | one on TAN COLLEE couee coo | ame [MEROHOO ak | n connie ” ™ wm [wm | mm | ww | ma Ls eeeenvepateeeeanpeen ests Gi a eae RNR ee