Region : Region I

Division :
School ID:
Name of Office / School :

To be Encoded
Manually

Summary from
I.Personal

Total no. of Authorized Positions (per

PSI-POP):
Total no. of Filled-up Plantilla Positions:
Total no. of Personnel Re-assigned to:
Total no. of Personnel reassigned from:
Total no. of contractual employees:
Total no. of casual employees:
Total no. of locally funded employees:

0
0
0

NA
UNIQUE ITEM NUMBER

POSITION TITLE PER

PLANTILLA

PARENTHETICAL TITLE

SALARY
GRADE

SALARY STEP
LAST NAME

NAME OF PERSONNEL
SEX
FIRST NAME

MIDDLE NAME

NAME EXTENSION

DATE OF BIRTH
(MM-DD-YYYY)

TIN

DATE OF ORIGINAL
DATE OF LAST
APPOINTMENT (AS
PROMOTION /
NATIONAL) (MM-DD- APPOINTMENT (MM-DDYYYY)
YYYY)

EMPLOYMENT
STATUS

FUNDING

PLACE OF BIRTH
(TOWN, PROVINCE OR
CITY)

CIVIL STATUS

Height (m) Weight (kg) Blood Type

GSIS BP No.

PAG-IBIG
PHILHEALTH No.
No. (Inc but
(Inc but not
not
required)
required)

SSS No.

Address (House No, Street Name,

Village/Subd)

Residential Address (Inc but not required)

Region

Province / District / City

City/ Municipality

Barangay

Telephone No.

Permanent Address (Required)

Address (House No, Street Name,
Village/Subd)

Region

Province / District / City

City / Municipality

Reassigned From
Barangay

Telephone No.

Email Address
(preferably
@deped.gov.ph)

Cellphone No. (if any)

Reassigned From:
Region/ Division/ District

Reassigned From
Reassigned From: School ID

Languages/Dialect
Spoken

NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME EXTENSION)

RELATIONSHIP

LAST NAME

FIRST NAME

MIDDLE NAME

FOR CHILD ONLY

FOR SPOUSE ONLY
DATE OF BIRTH (MM-DD-YYYY) OCCUPATION EMPLOYER/BUS. NAME

OR SPOUSE ONLY
BUSINESS ADDRESS TELEPHONE NO.

NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME EXTENSION)

EDUCATIONAL BACKGROUND
INCLUSIVE YEAR
LEVEL

Name of School

From

INCLUSIVE YEAR
To

Year Graduated

Highest Grade/Level/Units
Earned (if not graduated)

Course

Major

Minor

Honors
Received

Enter trainings within the last five years starting with the most recent
NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME EXTENSION)

e most recent
TITLE OF SEMINAR

AREA OF TRAINING

INCLUSIVE DATES (MM-DD-YYYY)

FROM
TO

NO. OF HOURS

CONDUCTED BY

PLACE OF TRAINING

NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME EXTENSION)

ELIGIBILITY

RATING

DATE OF EXAM/
CONFERMENT (MMDD-YYYY)

PLACE OF EXAM /
CONFERMENT

LICENSE
NUMBER

ISSUE DATE (MM-DDYYYY)

NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME EXTENSION)

WORK EXPERIENCES
INCLUSIVE DATE (MM-DD-YYYY)
FROM
TO

POSITION TITLE

ORK EXPERIENCES
DEPARTMENT / AGENCY / OFFICE

MONTHLY
SALARY

SALARY
RANGE/GRADE

STEP
INCREMENT

STATUS OF
APPOINTMENT