CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15338442

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 AUSTRAL
FIRST NAME JEE RHO
MIDDLE NAME SITE 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS Zone 7 Riverside,Canduman , MANDAUE CITY, CEBU

4. DATE OF BIRTH (mm/dd/yyyy) 04 / 20 / 1996
5. PLACE OF BIRTH Cebu City
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 6014
Married Separated
17. TELEPHONE NO. 2687581
Annuled Others, specify
_________ 18. PERMANENT ADDRESS Zone 7 Riverside, Canduman, MANDAUE CITY, CEBU

8. CITIZENDSHIP Filipino
9. HEIGHT (m) 157.48
10. WEIGHT (kg) 47 ZIP CODE 6014
11. BLOOD TYPE O+ 19. TELEPHONE NO. 2687581
12. GSIS ID NO. 20. EMAIL ADDRESS (if any) australjeerho@gmail.com
13. PAGIBIG ID NO. 21. CELLPHONE NO. (if any) 09231364951
14. PHILHEALTH NO. 120256082581 22. AGENCY EMPLOYEE NO.

15. SSS NO. 06-3281534-6 23. TIN

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/a 01 / 01 / 1970

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME Austral

FIRST NAME Jesse

MIDDLE NAME Quillope

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Site

FIRST NAME Roaida

MIDDLE NAME Pilapil

III. EDUCATIONAL BACKGROUND

HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS SCHOLARSHIP/ ACADEMIC
GRADUATED
(Write in full) (Write in full) EARNED HONORS RECEIVED
(if graduated)
(if not
graduated) From To

Cabancalan Elementary
ELEMENTARY 2002 2002 2008 N/A
School

Cabancalan National High

SECONDARY 2012 2008 2012 N/A
School

VOCATIONAL/ TRADE
N/A N/A N/A N/A N/A
COURSE

University of Cebu Lapu-Lapu Bachelor in

COLLEGE 2016 2012 2016 N/A
and Mandaue Elementary Education

GRADUATE STUDIES N/A N/A N/A N/A N/A

IV. CIVIL SERVICE ELIGIBILITY

AUSTRAL, JEE RHO SITE - T15338442 CS FORM 212 (Revised 2005), Page 1 of 3
29. LICENSE (if applicable)
DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE
LET (LICENSURE EXAMINATION FOR
76.20 09 / 24 / 2017 Zapatera Elementary School 18-1178875 02/18/2019
TEACHER)

V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")

10/15/2017 01/24/2019 Private Teacher Honey Hosea Academy Inc. 8000 0-0 Contractual No

ESL teacher (English as a Second

08/01/2017 09/01/2017 MJ Global Academy 10,000 0-0 Contractual No
Language)

ESL teacher (English as a Second

07/13/2016 11/30/2016 Ye-a Kids Academy 8000 0-0 Contractual No
Language)

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF
POSITION / NATURE OF WORK
(Write in full) HOURS
From To

CBMS( Community Monitoring Based System)/Enumerator 01 / 15 / 2017 03 / 17 / 2017 8 Enumerator

VII. TRAINING PROGRAMS (Start from the most recent training.)

32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

Abot- Alam Program for Quarter 1 of 2016 01 / 07 / 2016 01 / 07 / 2016 5 Ismaelita N. Desabille

VIII. OTHER INFORMATION

33. 34. 35. MEMBERSHIP IN ASSOCIATION /
NON-ACADEMIC DISTINCTIONS / RECOGNITION:
SPECIAL SKILLS / HOBBIES: ORGANIZATION
(Write in full)
(Write in full)

surfing internet, reading books,coloring and

N/a College of Education
drawing

AUSTRAL, JEE RHO SITE - T15338442 CS FORM 212 (Revised 2005), Page 2 of 3
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees): YES NO

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 If YES, give details:
appointed? _____________________________________
_____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where you will be appointed?
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37. a. Have you ever been formally charged? YES NO

If YES, give details:
_____________________________________
_____________________________________

b. Have you ever been guilty of any administrative offense? YES NO

If YES, give details:
_____________________________________
_____________________________________

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
_____________________________________
_____________________________________

39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
_____________________________________
_____________________________________

40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
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:

a. Are you a member of any indigenous group? YES NO

If YES, please specify:_______________________
b. Are you differently abled? YES NO
If YES, please specify:_______________________
c. Are you a solo parent? YES NO
If YES, please specify:_______________________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

Femmie Marie T. Pinote San Roque, Pusok Lapu-Lapu City 2687581

Joanna Abing Ibo, Lapu-Lapu City 09339447078

Genli B. Comaingking Ibo, Lapu-Lapu City 09351213641

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.
X
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that
this information shall remain confidential. PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT SIGNATURE (Sign inside the box)

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

AUSTRAL, JEE RHO SITE - T15338442 CS FORM 212 (Revised 2005), Page 3 of 3