P. 1
Copy of 16143413 Personal Data Sheet CS Form 212

Copy of 16143413 Personal Data Sheet CS Form 212

|Views: 1,807|Likes:

More info:

Published by: Girlie Joyce Agustin on Jun 14, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as XLS, PDF, TXT or read online from Scribd
See more
See less

04/21/2013

pdf

text

original

CS FORM 212 (Revised 2005

)

PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME FIRST NAME MIDDLE NAME

PACCARANGAN ERNESTO JR. GUMIRAN 02/19/1950 Fem ale Widowed Separated
ZIP CODE 17. TELEPHONE NO. 16. RESIDENTIAL ADDRESS 3. NAME EXTENSION (e.g. Jr., Sr.)

4. DATE OF BIRTH (mm/dd/yyyy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS

CENTRO STO. TOMAS, ISABELA Male Single Married

173 JUAN MIGUEL STREET , VIRA ROXAS, ISABELA 3320

18. Annulled Others, specify ___________ PERMANENT ADDRESS 8. CITIZENSHIP 9. HEIGHT (m) 10. WEIGHT (kg) 11. BLOOD TYPE 12. GSIS ID NO. 13. PAG-IBIG ID NO. 14. PHILHEALTH NO. 15. SSS NO.

FILIPINO 1.7 M 65 KG TYPE O BJOCKEG9017
ZIP CODE 19. TELEPHONE NO.

173 JUAN MIGUEL STREET , VIRA ROXAS, ISABELA 3320

20. E-MAIL ADDRESS (if any) 21. CELLPHONE NO. (if any)09084468976

06-000035602-9

22. AGENCY EMPLOYEE NO. 23. TIN

199-866-492

II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME FIRST NAME

PACCARANGAN CELIA AGRICULTURIST GOVERNMENT UNIT

25. NAME OF CHILD (Write full name and list all) OF BIRTH (mm/dd/yyyy) DATE

ERNICEL P. PACCARANGAN REDENTOR P. PACCARANGAN SNOOKY P. PACCARANGAN PEDRO P. PACCARANGAN

09/19/1977 01/29/1980 11/26/1982 03/29/1985 / / / / / / / / / / /

MIDDLE NAME BAGUNU OCCUPATION

EMPLOYER/BUS. NAME LOCAL BUSINESS ADDRESS TELEPHONE NO.

ROXAS, ISABELA

(Continue on separate sheet if necessary) 26. FATHER'S SURNAME FIRST NAME MIDDLE NAME

/ / / / / / /

PACCARANGAN ERNESTO SR. MANALO

27. MOTHER'S MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME

GUMIRAN CONSTANTINO CALLUENG

III. EDUCATIONAL BACKGROUND
28. LEVEL NAME OF SCHOOL (Write in full)

YEAR (Continue on separate sheet if necessary) GRADUATE D HIGHEST INCLUSIVE DATES OF GRADE/ LEVEL/ DEGREE COURSE SCHOLARSHIP/ ATTENDANCE UNITS (Write in ACADEMIC EARNED full) HONORS RECEIVED From To (if not graduated)

ELEMENTARY VOCATIONAL / SECONDARY

STO. TOMAS CENTRAL SCHOOL CAGAYAN VALLEY INSTITUTE OF TECHONOLOGY GREGORIO PERFECTO AQUINO VOCATIONAL SCHOOL

GRADE VI

1963 graduated
)

(if

1957 1963 1968

1963 1967 1969

HIGH SCHOOL 1967 SECRETARIAL 1969 BACHELOR OF SCIENCE IN AGRICULTURE 1976 MASTER IN 1995 BUSINESS ADMINISTRATI ON

COLLEGE TRADE COURSE

CAGAYAN VALLEY INSTITUTE OF TECHONOLOGY INSTITUTE OF TECHNOLOGY

1972 1992

1976 1995

GRADUATE STUDIES

ISABELA COLLEGES

(Continue on separate sheet if necessary) Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
29. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE RATING DATE OF EXAMINATIO N/ CONFERMENT PLACE OF EXAMINATION / CONFERMENT DATE LICENSE (if applicable) OF RELEAS NUMBER E

CULTURAL COMMUNITY OFFICER AGRICULTURIST

TUGUEGARAO CAGAYAN MANILA CITY 0005205

MAY 30, 1980 AUGU

ST 10, 2006

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. INCLUSIVE DATES (mm/dd/yyyy) From To POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)
MONTHLY SALARY
SALARY GRADE & STEP INCREMENT (Format "000")

GOV'T SERVICE

STATUS OF APPOINTMENT

01/01/201 TO DATE AGRICULTURIST I 0 01/01/200 12/31/200 AGRICULTURIST I 9 9 07/01/200 12/31/200 AGRICULTURIST I 8 8 07/01/200 06/30/200 AGRICULTURIST I 7 8 01/01/200 06/30/200 AGRICULTURIST I 6 7 01/01/200 12/31/200 AGRICULTURIST I 3 5

LOCAL GOVERNMENT UNIT LOCAL GOVERNMENT UNIT LOCAL GOVERNMENT UNIT LOCAL GOVERNMENT UNIT LOCAL GOVERNMENT UNIT LOCAL GOVERNMENT UNIT

PERMANEN (Yes YES / T No) PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T
CS FORM 212 (Revised 2005), Page 2 of 4

01/01/200 12/31/200 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 2 2 01/01/200 12/31/200 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 1 1 01/01/200 12/31/200 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 0 0 01/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 9 9 01/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 8 8 11/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 7 7 09/01/199 10/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 7 7 01/01/199 08/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 7 7 01/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 6 6 01/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 5 5 01/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 4 4 04/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 3 4 01/01/199 03/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 3 3 01/01/199 12/31/199 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT 2 2
(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. INCLUSIVE DATES (mm/dd/yyyy) From To POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)
MONTHLY SALARY
SALARY GRADE & STEP INCREMENT (Format "000")

GOV'T SERVICE

STATUS OF APPOINTMENT

01/10/199 12/31/199 DEPARTMENT OF AGRICULTURAL TECHNOLOGIST 1 1 AGRICULTURE 01/01/199 08/31/199 DEPARTMENT OF AGRICULTURAL TECHNOLOGIST 0 1 AGRICULTURE 07/01/198 12/31/198 DEPARTMENT OF AGRICULTURAL TECHNOLOGIST 9 9 AGRICULTURE 07/01/198 06/30/198 DEPARTMENT OF AGRICULTURAL TECHNOLOGIST 8 9 AGRICULTURE 01/01/198 06/30/198 DEPARTMENT OF AGRICULTURAL TECHNOLOGIST 8 8 AGRICULTURE 03/01/198 12/31/198 AGRICULTURE FOOD 7 7 TECHNOLOGIST 09/01/198 02/28/198 AGRICULTURE FOOD 5 7 TECHNOLOGIST 01/01/198 08/31/198 FARM MANAGEMENT 5 5 TECHNILOGIST 05/01/198 12/31/198 FARM MANAGEMENT 4 4 TECHNILOGIST 03/01/198 04/30/198 FARM MANAGEMENT 1 4 TECHNILOGIST 08/02/198 02/28/198 FARM MANAGEMENT 0 1 TECHNILOGIST 08/02/197 08/01/198 FARM MANAGEMENT 9 0 TECHNILOGIST 08/02/197 08/01/197 FARM MANAGEMENT 8 9 TECHNILOGIST 08/02/197 08/01/197 FARM MANAGEMENT 7 8 TECHNILOGIST MINISTRY OF AGRICULTURE MINISTRY OF AGRICULTURE

3,164.0 0 3,133.0 0 3,102.0 0 1,778.0 0 1,458.0 0 1,251.5 8 1,042.9 1

PERMANEN (Yes YES / No) T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T PERMANEN YES T TEMPORAR YES Y TEMPORAR YES Y TEMPORAR YES Y TEMPORAR YES Y TEMPORAR YES Y

MINISTRY OF AGRICULTURE 813.00 MINISTRY OF AGRICULTURE 736.00 BUREAU OF AGRI. EXTENSION BUREAU OF AGRI. EXTENSION BUREAU OF AGRI. EXTENSION BUREAU OF AGRI. EXTENSION BUREAU OF AGRI. EXTENSION 666.00 603.00 603.00 506.00 517.00 12.00/D ay 920 w/a

05/11/197 07/31/197 RURAL BANK OF SUPERVISING CROP TECHNICIAN 7 7 MAGSAYSAY 11/01/197 11/30/197 CAMPAINING CLERK 0 1 TREASURER'S OFFICE STO. TOMAS, ISABELA

/

/

/

/
(Continue on separate sheet if necessary) CS FORM 212 (Revised 2005), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATIO
INCLUSIVE DATES 31. NAME & ADDRESS OF ORGANIZATION (Write in full) (mm/dd/yyyy) From To NUMBER OF HOURS POSITION / NATURE OF WORK

/ / / / /

/ / / / /

/ / / / /

/ / / / /

(Continue on separate sheet if necessary)

VII. TRAINING PROGRAMS (Start from the most recent training.)
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full) INCLUSIVE DATES OF ATTENDANCE From (mm/dd/yyyy) To NUMBER CONDUCTED/ SPONSORED BY OF HOURS (Write in full)

EXTENSION DELIVERY SYSTEM FOR MUNICIPAL AGRICULTURIST SEED CERTIFICATION ON HYBRID RICE STRENGTENING DA-LGU LINKAGE TRAINING WORKSHOP RETOOLING OF AGRICURAL TECHNOLOGIST ON RICE PRODUCTION HYBRID SEED PRODUCTION UNIVERSITY WITHOUT WALLS SEED INSPECTOR'S REFRESHOR COURSE

01/18/2010 03/19/2010 16 09/24/2003 09/25/2003 16 05/22/2002 05/24/2002 24 03/29/2001 03/31/2001 24 01/27/2000 03/15/2000 384 11/04/1998 11/06/1998 24

AGRICULTURAL TRAINING INSTITUTE RTC SAN MATEO PHILRICE SAN MATEO, ISABELA AGRI. TRAINING INST.RTCRD & DEPT. OF AGRICULTURE AGRICULTURAL TRAINING INSTITUTE RTC - RD PHILRICE SAN MATEO, ISABELA AGRICULTURAL TRIANING INSTITUTE SAN MATEO, ISABELA AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA AGRICULTURAL TRAINING INSTITUTE RTC-RD AGRICULTURAL TRAINING INSTITUTE RTC-RD AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA CAG. VALLEY AGRICULTURAL RESEARCH CENTER AGRICULTURAL TRAINING INSTITUTE RTC-RD AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA

SPECIALIZED TRAINING COURSE ON HYBRID RICE 08/26/1997 08/29/1997 32 SEED PRODUCTION GINTONG ANI CORN PRODUCTION, RETOOLING OF AGRICULTURAL TECHNOLOGIST TRAINING ON POST HARVEST TECHNOLOGY SEED INSPECTOR'S TRAINING AGRIBUSINESS ENTREPRENEUR DEVELOPMENT MANAGEMENT TRAINING SOYBEAN PRODUCTION 05/09/1996 05/11/1996 24 11/21/1994 11/23/1994 24 03/10/1993 03/12/1993 24 07/06/1992 07/10/1993 40 11/14/1991 / / 8

TRAINING ON FARMING SYSTEM AS ENTERPRISE 09/23/1990 09/29/1990 56 TO CARP II RICE PRODUCTION ENHANCEMENT PROGRAM II 10/02/1989 10/03/1989 16 / / / /

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION: 33. SPECIAL SKILLS / HOBBIES: 34. (Write in full) 35.

MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)

TYPING, READING NEWSPAPERS

OUTSTANDING SEED INSPECTOR YEAR 20002 MARRIAGE ENCOUNTER PROVINCIAL AND REGIONAL CONTESTANT "KABALIKAT NG MAGSASAKA AWARD" YEAR 1984

(Continue on separate sheet if necessary) CS FORM 212 (Revised 2005), Page 3 of 4

VII. TRAINING PROGRAMS (Start from the most recent training.)
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full) INCLUSIVE DATES OF ATTENDANCE From (mm/dd/yyyy) To NUMBER CONDUCTED/ SPONSORED BY OF HOURS (Write in full)

EXTENSION DELIVERY SYSTEM FOR MUNICIPAL AGRICULTURIST SEED CERTIFICATION ON HYBRID RICE STRENGTENING DA-LGU LINKAGE TRAINING WORKSHOP RETOOLING OF AGRICURAL TECHNOLOGIST ON RICE PRODUCTION HYBRID SEED PRODUCTION UNIVERSITY WITHOUT WALLS SEED INSPECTOR'S REFRESHOR COURSE

01/18/2010 03/19/2010 09/24/2003 09/25/2003 05/22/2002 05/24/2002 03/29/2001 03/31/2001 01/27/2000 03/15/2000 11/04/1998 11/06/1998

16 16 24 24 384 24 32 24 24 24 40 8 56 16

AGRICULTURAL TRAINING INSTITUTE RTC SAN MATEO PHILRICE SAN MATEO, ISABELA AGRI. TRAINING INST.RTCRD & DEPT. OF AGRICULTURE AGRICULTURAL TRAINING INSTITUTE RTC - RD PHILRICE SAN MATEO, ISABELA AGRICULTURAL TRAINING AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA AGRICULTURAL TRAINING INSTITUTE RTC-RD AGRICULTURAL TRAINING INSTITUTE RTC-RD AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA CAG. VALLEY AGRICULTURAL RESEARCH CENTER AGRICULTURAL TRAINING INSTITUTE RTC-RD AGRICULTURAL TRAINING INSTITUTE SAN MATEO, ISABELA

SPECIALIZED TRAINING COURSE ON HYBRID RICE 08/26/1997 08/29/1997 SEED PRODUCTION GINTONG ANI CORN PRODUCTION, RETOOLING OF AGRICULTURAL TECHNOLOGIST TRAINING ON POST HARVEST TECHNOLOGY SEED INSPECTOR'S TRAINING AGRIBUSINESS ENTREPRENEUR DEVELOPMENT MANAGEMENT TRAINING SOYBEAN PRODUCTION 05/09/1996 05/11/1996 11/21/1994 11/23/1994 03/10/1993 03/12/1993 07/06/1992 07/10/1993 11/14/1991 / /

TRAINING ON FARMING SYSTEM AS ENTERPRISE 09/23/1990 09/29/1990 TO CARP II RICE PRODUCTION ENHANCEMENT PROGRAM II 10/02/1989 10/03/1989 / / / /

36. Are

you related by consanguinity or affinity to any of the following : YES NO If YES, give details: ____________________________________ _ ____________________________________ _ ____________________________________ YES NO _ If YES, give details: ____________________________________ _ ____________________________________ _ YES NO ____________________________________ I _f YES, give details: ________________________________ ________________________________ YES NO If YES, give details: ________________________________ ________________________________ YES NO If YES, give details: ________________________________ ________________________________ YES NO

a. Within

the third degree (for National Government Employees): appointing authority, recommending authority, chief of office/bureau/department or person who has immediate supervision over you in the Office, Bureau or Department where you will be appointed? the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?

b. Within

37 a.

Have you ever been formally charged?

b. Have you ever been guilty of any administrative offense?

38. Have

you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?

39. Have

you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the rolls, dismissal, termination, end of term, finished contract, AWOL or phased out, in the public or private sector?

If YES, give details: ________________________________ ________________________________ YES NO

40. Have

you ever been a candidate in a national or local election (except Barangay election)?

If YES, give details: ________________________________ ________________________________

41. 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: Are you a member of any indigenous group? Are you differently abled? Are you a solo parent? YES NO If YES, please specify: ____________________ YES NO If YES, please specify: ____________________ YES NO If YES, please specify: ____________________

a. b. c.

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO.
ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size) Computer generated or xerox copy of picture is not acceptable

43. I

declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential. 13439623
COMMUNITY TAX CERTIFICATE NO.

PHOTO

ROXAS, ISABELA
ISSUED AT SIGNATURE (Sign inside the box)

01/05/2010
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->