Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
212
Revised 2017
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do
I. PERSONAL INFORMATION
2. SURNAME MAMON
NAME EXTENSION (JR., SR
FIRST NAME CELEE ANN KRIS
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) krislee ann_17@yahoo.com
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
SURNAME AGUILO
TRADE 4TH
GORDON COLLEGE/ ST.JOSEPH COLLEGE BACHELOR OF SCIENCE IN HOTEL AND RESTAURANT MANAGEMENT/
COURSE
COLLEGE
OLONGAPO-INC
BACHELOR OF SCIENCE IN SECONDARY EDUCATION MAJOR IN
FILIPINO
2004/2013 2008/2015 HONORABLE
MENTION
GRADUATE STUDIES
SIGNATURE DATE
CS FORM
L DATA SHEET
Dual Citizenship
by naturalization
HARRIS ST.
Street
EAST BAJAC-BAJAC
Barangay
ZAMBALES
Province
HARRIS ST.
Street
EAST BAJAC-BAJAC
Barangay
ZAMBALES
Province
222-8430
09090265182/09164170549
krislee ann_17@yahoo.com
7/24/2010
5/17/1962
11/6/1963
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
2000
2004
4TH
2008-2015 HONORABL
E MENTION
LICENSURE EXAMINATION FOR TEACHERS 9/24/2015 FAMILY CLINIC SAMPALOC MANILA 1414531
SIGNATURE DATE
CS FORM 212 (Revised 20
LICENSE (if applicable)
Date of
Validity
GOV'T
SERVICE
(Y/
N)
N
arate sheet if necessary)
N/A N/A
CENTRAL L
TEST CONSTRUCTION,TOS, ITEM ANALYSIS 8/12/2016 8/12/2016 8.0 MANAGERIAL
CENTRAL L
ITEM ANALYSIS, INSTRUCTIONAL GUIDE/ WORKSHOP 5/10/2016 5/16/2016 8.0 MANAGERIAL
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
N/A
CONDUCTED/ SPONSORED BY
(Write in full)
PUP, MANILA
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
N/A
b. within the fourth degree (for Local Government Unit - Career Employees)? YES
If YES, give details:
________________________________
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:
ID/License/Passport No.:
Signature (Sign inside the box)
Date/Place of Issuance:
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.