Personal Data Sheet 2015 Tesda

CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET Print legibly. Mark appropriate boxes

with "

1. CS ID No.

" and use separate sheet if necessary.

(to be filled up by CSC)

I. PERSONAL INFORMATION  % & $ &

2. S! S!#M #M$ $

' & # &

& !

& 

*!S+ #M$

% & $ & M & $ &

M*%%'$ #M$

, & # & ! & ! & & - &

+ & ! & *

&

# &

&  &

 &

&

& &

&

& &

&

& &

&

& &

&

& &

&

& &

&

& &

&

& &

&

& &

&

& &

&

%#<P# C*+= Male

7. S$/ :. C*?*' S+#+ S+#+S S

-*P C%$

Married

Separated

#nnulled

thers1 specify     8;. P$!M#$+ #%%!$SS

9. 3$*<3+ 3$*<3+ (4)

5'8"

86. 86. @$*<3 @$*<3+ + (kg) (kg)

65 !

88. 88. ,'% ,'% +=P$

0

&

& &

& &

& &

& &

& &

& &

&

& &

& . #M$ $/+$S* (e.g. 0r.1 Sr.)

& &

& &

& &

&

JR/

266 696::>97>2

8:. +$'$P3$ .

86: +#M,#C %*S+!* C+1 %#<P# C*+=1 C*+=1 P#<#S*#

-*P C%$

266

89. +$'$P3$ .

696::>97>2

26. $AM#*' #%%!$SS (if any)

[email protected]

1210#6$202#

28. C$''P3$ . (if any)

696::>97>2

8. P3*'3$#' P3*'3$#'+3 +3 . .

22. #<$C= $MP'=$$ .

8>. 8>. SS SSS S . .

2168%815

2. +*

82. 82.
&

e4ale @idowed

FILIPINO

&

&

86: +#M,#C %*S+!* C+1 %#<P# C*+=1 C*+=1 P#<#S*#

Single

;. C*+*-$ C*+*-$S3 S3*P *P

&

87. !$S*%$+*#' #%%!$SS

6756589:;

. %#+$  ,*!+3 ,*!+3 (445dd5yyyy) (445dd5yyyy) >. P'#C$ P'#C$   ,*!+3 ,*!+3

&S

28>;6>:666

II. FAMIL FAMILY Y BACKGROUND 2. SPS$B SPS$BS S!#M S!#M$ $

%$'# !S#

2>.  #M #M$  C3*'% (@rite full na4e and list all)

%#+$  ,*!+3 (445dd5yyyy)

 *!S+ #M$

&IR!I

%$?*$ . %$'# !S#

65875266;

  M*%%'$ #M$

*NDO

%$M?$! . %$'# !S#

6>52852688

CCP#+*

5#

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5

$MP'=$!5,S. #M$

5#

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,S*$SS #%%!$SS

5#

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+$'$P3$ . (Continue on sepaate s!eet i" ne#essa

%$27. #+3$!BS S!#M$

67528589>

%$'# !S# S!.

*!S+ #M$

%$M$+!*

 5

5

M*%%'$ #M$

#%!$S

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5

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5

2:. M+3$!BS M#*%$ #M$ S!#M$

%$'# !S#

*!S+ #M$

$SP$!#-#

M*%%'$ #M$

,#!!-

675258978  5

5

(Continue on sepaate s!eet i" ne#essa

%$III. EDUCA EDUCATIONAL TIONAL BACKGROUND 2;.

#M$  SC3' '$?$'

(@rite in

%$
full)

$'$M$+#!=

+#M,#C $'$M$+#!= SC3'

8998

S$C%#!=

S+. 03 C#+3$%!#' 3*<3 SC'

899>

C''$<$


*C'S*?$ %#+$S  #++$%#C$

3*<3$S+
(@rite in full)

ro4

+o

8998 8998

899>

*?$!S*+=  P#<#S*#

,#C3$'!  SC*$C$ * CMP+$! 266 $<*$$!*<

899>

2666

% M#!*# M#!CS M$M!*#' S+#+$ S+#+$ *?$!S*+= *?$! S*+=

M.#. * M#+3$M#+*CS

266:

2669

2666

SC3'#!S3*P5 #C#%$M*C 3!S !$C$*?

%$+3$ MS+ !$C$P*$+ * %$S*< P!0$C+ * ,SCP$

(Continue on sepaate s!eet i" ne#essa

%$Page 8 of 

I&. CI&IL SER&ICE ELIGIBILITY  29.

C#!$$! S$!?*C$5 !# 86;6 (,#!%5 ,#!) %$! SP$C*#' '#@S5 C$S5 CS$$

PROFSSION*L C*RR SR&IC

!#+*<

;.>6D

N*+ION*L CR+IFIC*+(NC;2) COMP+R *RD<*R SR&ICIN!

'*C$S$ (if applicable)

%#+$  $/#M*#+* 5 C$!M$+

P'#C$  $/#M*#+* 5 C$!M$+

M,$!

%#+$  !$'$#S$

6:5252662

CSC C*R R!ION

66868@$

6:5252662

86525266;

+SD* LIN!*,N- P*N!*SIN*N

6968662669:6 6258>52669

(Continue on sepaate s!eet i" ne#essa

%$&. 'ORK EPERIENCE (In#)u*e pi+ate e,p)o$,ent. Stat "o, $ou #uent -o% 6.

*C'S*?$ %#+$S (445dd5yyyy) ro4

PS*+* +*+'$ (@rite in full)

+o

%$P#!+M$+ 5 #<$C= 5 *C$ 5 CMP#= (@rite in full)

M+3'= S#'#!=

S#'#!=
<?B+ S$!?*C$ S+#+S   #PP*+M$+ (=es 5 o)

  6:58752666

685 875266

MIS S

J*P*N CIRCI+ +CNOLO!, CORPOR*+ION/Po34ee De7e

86666

!$<'#!



 6 5825266

6 5 2; 52669

I+ Is43o

ivesi o L49o

82666

!$<'#!

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6 52; 52682

Co74e Is43o/Rese3=e

Do Mio M3os Meoi: Se ivesi

89666

!$<'#!

yes

69 5 8852669

 

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5 (Continue on sepaate s!eet i" ne#essa$% CS !M 282 (!eEised 266>)1 Page 2 of 

&I. &OLUNTARY 'ORK OR IN&OL&EMENT IN CI&IC / NON0GO&ERNMENT / PEOPLE / &OLUNTARY ORGANI1ATION/S *C'S*?$ %#+$S 8.

#M$ F #%%!$SS  !<#*-#+* (@rite in full)

M,$!  3!S

(445dd5yyyy) ro4

*SSOCI*+ION OF COMP+R N!INRIN! S+DN+ CONCIL

PS*+* 5 #+!$  @!G

+o

67 5 82 5899>

675 8 5899:

 

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26 3!S M$M,$!  S+%$+ CC*'

(Continue on sepaate s!eet i" ne#essa

%$&II. TRAINING PROGRAMS (Stat "o, t!e ,ost e#ent tainin2.% *C'S*?$ %#+$S  #++$%#C$ 2.

+*+'$  S$M*#!5C$!$C$5@!GS3P5S3!+ C!S$S (@rite in full)

M,$!  3!S

(445dd5yyyy) ro4

 C%C+$%5 SPS!$% ,= (@rite in full)

+o

D*+* COMMNIC*+IONS *ND N+
6;52858999

6;522 58999

87 3!S #+*#'CMP+$! C$+$!

<P*! DSI!N *ND N+
6;56758999

6;56:58999

87 3!S C$ CMP+$!S

+M+P 1

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62 567 52669

 3!S +$S%# '*<#=$ P#<#S*#

6>58> 52669

 3!S +$S%# '*<#=$ P#<#S*#

C*MC

6>58852669

ISO 1001 d ISO $001(>4:i M?ee d vioe *@eess)

6752852666

67 5 22 52666 87 3!S 0apan Circuit +echnology Corporation

 

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%$&III. OT3ER INFORMATION  .

SP$C*#' SG*''S 5 3,,*$SH

.

A#C#%$M*C %*S+*C+*S 5 !$C<*+*H (@rite in full)

>.

#SSC*#+*5!<#*-#+* (@rite

*+$!$+1 C3$SS1 ,#SG$+,#''1 ,#%M*+ $+C.

(Continue on sepaate s!eet i" ne#essa$%  CS !M 282 (!eEised 266>)1 Page  of 

7.

#re you related by consanguinity or affinity to any of the following H

a.

@ithin the third degree (for ational
b.

@ithin the fourth degree (for 'ocal
:

a. 3aEe you eEer been for4ally chargedI

=$S  *f =$S1 giEe detailsH        =$S



*f =$S1 giEe detailsH        =$S



*f =$S1 giEe detailsH      =$S

b. 3aEe you eEer been guilty of any ad4inistratiEe offenseI



*f =$S1 giEe detailsH      ;.

3aEe you eEer been conEicted of any cri4e or Eiolation of any law1 decree1 ordinance or regulation by any court or tribunalI

9.

3aEe you eEer been separated fro4 the serEice in any of the following 4odesH resignation1 retire4ent1 dropped fro4 the rolls1 dis4issal1 ter4ination1 end of ter41 finished contract1 #@' or phased out1 in the public or priEate sectorI

6.

3aEe you eEer been a candidate in a national or local election (except ,arangay election)I

=$S  *f =$S1 giEe detailsH      =$S



*f =$S1 giEe detailsH      =$S



*f =$S1 giEe detailsH      8.

Pursuant toH (a) *ndigenous PeopleBs #ct (!# ;:8)J (b) Magna Carta for %isabled Persons (!# :2::)J and (c) Solo Parents @elfare #ct of 2666 (!# ;9:2)1 please answer the following ite4sH

a.

#re you a 4e4ber of any indigenous groupI

=$S  *f =$S1 please specifyH  

b.

#re you differently abledI

=$S  *f =$S1 please specifyH  

c.

#re you a solo parentI

=$S  *f =$S1 please specifyH  

2. !$$!$C$S (Person not related by consanguinity or affinity to applicant 5 appointee) #M$

#%%!$SS

$
M#<#'%#1 P#<#S*#

!$$ M=#

M#<#'%#1 P#<#S*#

.

+$'. .

* declare under oath that this Personal %ata Sheet has been acco4plished by 4e1 and is a true1 correct and co4plete state4ent pursuant to the proEisions of pertinent laws1 rules and regulations of the !epublic of the Philippines. * also authoriKe the agency head 5 authoriKed representatiEe to Eerify 5 Ealidate the contents stated herein. * trust that this infor4ation shall re4ain confidential.

ID picture taken within the last 6 months 3.5 cm. X 4.5 cm passport si!e"

#omputer $enerated or %ero% copy o& picture is not accepta'le

P3+

82;2>9 CMM*+= +#/ C$!+**C#+$ .

%#<P# C*+= *SS$% #+

65825268 *SS$%  (445dd5yyyy)

S*<#+!$ (Si? iside =e AoB)

885275268 %#+$ #CCMP'*S3

%$!*<3+ +3M,M#!G

CS !M 282 (!eEised 266>)1 Page  of 