Personal Data Sheet Mbp

8/12/2019 Personal Data Sheet Mbp

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2004 2003-2004summer

2004

2009-20101st sem.

2010-2011

Page 1 of 4

GRADUATE STUDIES

24units

21 units

(Continue on separate sheet if necessary)

BSE

M.A. Math

City College of Urdaneta

Pangasinan State University,

Urdaneta Campus


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29.

NUMBER

81.0% 0882768

30.

To

Present 18735 11-2 P

05/31/2012 17318 11-2 P

05/31/2011 15900 11-2 P

09/27/2010 15649 11-1 P

06/23/2010 14198 11-1 P

06/30/2009 12026 10-1 P

06/30/2008 10933 10-1 P

09/24/2007 4000 LSB Contr'l

03/31/2007 4000 LSB Contr'l

03/01/2007 9939 10-1 Subst.

12/14/2006 9939 10-1 Subst.

10/10/2006 5720 Contr'l

05/31/2006 3600 Contr'l

01/15/2006 6600 Contr'l

05/31/2005 10500 Contr'l

/ /

/ /

Palaris Colleges

Malacaang National High School


HS & College

Instructor

Sec. Teacher

CSI-YES, San Carlos-Malasiqui

SST-I Malacaang National High School

SST-I Cobol National High School


SST-I Cobol National High School

SST-I

Merchandizer

NCR-Manuel L. Quezon HSLicensure Examination for

TeacherSaturday, August 14, 2004

Palaris Colleges

10/11/2006

Production

Operator

Universal Robina Corporation, Inc.

Calamba, Laguna02/01/2005

/ /

/ /

08/01/2005


SST-I


V. WORK EXPERIENCE (Include private employment. Start from your current work)

POSITION TITLE

(Write in full)

STATUS OF

APPOINTMENT

SALARY GRADE

& STEP

INCREMENT

(Format "00-0")

MONTHLY

SALARY

INCLUSIVE DATES (mm/dd/yyyy)

From




09/28/2010

SST-I

CAREER SERVICE/ RA 1080 (BOARD/ BAR)

UNDER SPECIAL LAWS/ CES/ CSEE

DATE OF EXAMINATION /

CONFERMENTPLACE OF EXAMINATION / CONFERMENT

LIC

RATING

IV. CIVIL SERVICE ELIGIBILITY

06/01/2011

SST-I

DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full)

06/01/2012 Malacaang National High School

06/24/2010

04/05/2006

07/01/2009

07/01/2008

09/28/2007

01/08/2007

06/01/2007

06/01/2006

03/02/2007


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/ /

/ /

/ /

CS FORM


/ /

/ /

/ /


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DATE OF RELEASE

##################

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

GOV'T SERVICE

(Yes / No)

NSE (if applicable)


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212 (Revised 2005), Page 2 of 4


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From To

/ / / /

/ / / /

/ / / /

From To

11/29/2008 12/06/2008

16 Hrs.

04/17/2009 04/19/200924 Hrs.

09/30/2009 10/1,2,3 /200932 Hrs.

11/15/2009 11/17/200924 Hrs.

3/25/201 03/27/201024 Hrs.

03/21/2011 03/22/201116 Hrs.

05/10/2011 05/13/201132 Hrs.

07/29/2011 07/31/2011 32 Hrs.

05/14/2012 05/18/201240 Hrs.

06/13/2012 06/15/201232 Hrs.

10/21/2012 10/22/201216Hrs.

03/21/2013 03/22/201316Hrs.

03/05/2013 04/26/2013

09/12/2013 09/14/2013

24Hrs.

10/08/2013 10/08/20138Hrs.

CONINCLUSIVE DATES OF ATTENDANCE

(mm/dd/yyyy)32.

DepEd

Deped-

DIVISION OFFICIATING OFFICIALS ACCREDITITATION

SEMINAR

Deped-

Parents' & Teachers Camp 2012

Division Taining for Mathematics Teachers

K to 12 Regional Mass Training for Grade 7 Mathematics

Teachers

GURO21 Course 1-Facilitating the Development of the 21st

Century Skills for Southeast Asian Teachers

2-Day Regional Training on " The teaching of reading in the

Context Areas"

DepEd

Profes

Center

VII. TRAINING PROGRAMS

DepEd

EducatSEAM

Megaci

Basic Training Course for Outfit Advisers (Boy Scout of thePhilippines)

Boy ScSEPNA

Regional Seminar/Workshop on the Preparation of FY 2014

Budget Proposal

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

TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in

full)


NAME & ADDRESS OF ORGANIZATION

(Write in full)31.

Regional Mass Training of 2nd Year Teachers Teaching

Science and MathematicsDepEd

Batch 4 (375 NHS) and Batch 5 (675) of the DepEd

Computerization Program (DCP)

Regional Seminar/Workshop on the Preparation of FY 2012

Budget Proposal

NUMBER OF HOURS


VIII. OTHER INFORMATION

INCLUSIVE DATES

(mm/dd/yyyy)

NUMBER OF HOURS

POSI

Division4-Day Training -Workshop on Basic PC

troubleshooting, Repair and MaintenanceDepEd

Deped-

Panga

Regional Seminar/Workshop on Preparation of CY 2011

Budget ProposalDeped-

Gender Awareness And Development Tando

Regional Seminar/Workshop on the Preparation of CY 2009

Budget ProposalDepEd


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33. SPECIAL SKILLS / HOBBIES: 34. 35.NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)AS

2008Basket weaving, singing, swimming

TableTennis coaching

National

Philippi

Boy Sc

1st Place in Chariot Race (Div. Level) 2010 Div. BSP-GSP Camporal and

Encampment Nov.25-28,2010

1st Place in Ladder Makig Contest (Div. Level) 2010 Div. BSP-GSP

Camporal and Encampment Nov. 25-28,2010

Participant 5th National Science Quiz,Science Fair and Sci-Dama Feb. 04-

06,2008

2nd Place in Knot Tying (Div. Level) 2010 Div. BSP-GSP Camporal and

Encampment Nov. 25-28,2010

2nd Place in Ladder Making Contest (Div. Level) 2009 Div. BSP-GSP

Camporal and Encampment Nov. 22,2009

1st Place in Suspended Flag Pole (Div. Level) 2009 Div. BSP-GSP


3rd Place in Camp Fire Song and Yell (Div. Level) 2009 Div. BSP-GSP


Best Camp Set-Up (Div. Level) 2009 Div. BSP-GSP Camporal and

Encampment Nov. 22,2009

2nd Place in Suspended Flagpole (Div. Level) 2010 Div. BSP-GSP

Camporal and Encampment Nov. 25-28,2010

1st Place in Junk Art (Div. Level) 2010 Div. BSP-GSP Camporal and

Encampment Nov. 25-28,2010

Proctor-The 2009 Metrobank -MTAP-DepEd Math Challenge Jan.09,2009



2009

1st Place-Science Investigatory Project (Teacher Category) Regional

Science And Technology Day Dec. 18,2008

2010

2011

Scout Master-2009 Div. BSP-GSP Camporal and Encampment Nov.

22,2009

1st Place-Science Investigatory Project (Teacher Category) Regional

Science And Technology Day Jan. 23-25,2008

Scout Master-2010 Div. BSP-GSP Camporal and Encampment Nov.25-

28,2010

Chairman (Suspended Flagpole)-2010 Div. BSP-GSP Camporal and

Encampment Nov.25-28,2010

Facilitator-Regional Science Quest Jan. 14-16,2009

Chairman-2008 Div. Joint BSP-GSP Camporal and Encampment Nov. 13-

16,2008

Facilitator-Regional Science And Technology Day Jan. 23-25,2008


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Cleanliness Camp (Div. Level) 2012 Div. BSP-GSP Camporal and


1st Place in Ladder Making (Div. Level) 2012 Joint Div. BSP-GSP

Camporal and Encampment Dec. 06-09 2012

1st Place in Chariot Race (Div. Level) 2012 Joint Div. BSP-GSP Camporal

and Encampment Dec. 06-09 2012

2012

Best in Camp Setup (Div. Level) 2012 Joint Div. BSP-GSP Camporal and

Encampment Dec. 06-09 2012

Best in Gadget (Div. Level) 2012 Joint Div. BSP-GSP Camporal and

Encampment Dec. 06-09 2012

1st Place in Suspended Flag Pole (Prov. Level) 36th Pangasinan-San

Carlos City Council Jamborette and Kawan Holiday Nov. 22-25,2012

2nd Place in Modern Dance (Prov. Level) 36th Pangasinan-San Carlos

City Council Jamborette and Kawan Holiday Nov. 22-25,2012

3rd Place in Frontage (Prov. Level) 36th Pangasinan-San Carlos City

Council Jamborette and Kawan Holiday Nov. 22-25,2012

2nd Place in Camp Setup (Prov. Level) 36th Pangasinan-San Carlos City

Council Jamborette and Kawan Holiday Nov. 22-25,2012

Champion Scout Song and Yell (Div. Level) 2012 Joint Div. BSP-GSP

Camporal and Encampment Dec. 06-09 2012

3rd Place in Scout Action Songs and Yells (Div. Level) 2011 Div. BSP-

GSP Camporal and Encampment Dec. 08-11,2011

3rd Place in Chariot Race (Div. Level) 2011 Div. BSP-GSP Camporal andEncampment Dec. 08-11,2011

1st Place in Ladder Making (Div. Level) 2011 Div. BSP-GSP Camporal

and Encampment Dec. 08-11,2011

1st Place in Sack Race (Div. Level) 2011 Div. BSP-GSP Camporal and

Encampment Dec. 08-11,2011

2nd Place in Compass Setting (Div. Level) 2011 Div. BSP-GSP Camporal

and Encampment Dec. 08-11,2011

Coach-2nd Place Winner in Damath Level IV-2010 Div. Mathematics

Festival nov. 23-24,2010

Scout Master,Over all 2nd runner up-2012 Div. BSP-GSP Camporal and


Coach 5th Placer in Mathematics Relay-2012 Div. Mathematics Festival

Nov. 13-14,2012

Scout Master-36th Pangasinan-San Carlos City Council Jamborette and

Kawan Holiday Nov. 22-25,2012

Committee on Hall Preparation-23rd Nat'l Statistics Month Celebration

Oct. 04,2012

Scout Master-2011 Div. BSP-GSP Camporal and Encampment Dec. 08-

11,2011

Facilitator/Support Staff 22nd Nat'l Statistics Month Celebration Oct.

07,2011

Chairman(Suspended FlagPole)-2011 Div. BSP-GSP Camporal and

Encampment Dec. 08-11,2011


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CS FORM


a rman a er a ng on es - o n v. - ampora


3rd Place in Knot tying (Div. Level) 2012 Joint Div. BSP-GSP Camporal


Over-All 2nd Runner Up (Div. Level) 2012 Joint Div. BSP-GSP Camporal



11/16

UCTED/ SPONSORED BY

(Write in full)

La Union

La Union

La Union

& ARCZONE

ional Development

Turac NHS

ion Organization(EO INNOTECH &

ty Ministires Inc.

out of the Philippines-S

Mangaldan

TION / NATURE OF WORK

& SEPNAS

San fabian,

inan

La Union

Nhs-DepEd

RELC La Union


12/16

MEMBERSHIP IN

SOCIATION/ORGANIZATION

(Write in full)

Organization fo Professional

Teachers Inc.

e Red Cross

ut of the Philippines


13/16


14/16

212 (Revised 2005), Page 3 of 4


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36.

a.

b.

37

38.

39.

40.

41.

a.

b.

c.

42.

NAME ADDRESS

Malacaang NHS

Malacaang NHS

Mabalbalino NHS

PHOTO

01327932

COMMUNITY TAX CERTIFICATE NO.

43.

I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust

that this information shall remain confidential.

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.

If YES, give details:

_____________________________________

_____________________________________

_____________________________________

a. Have you ever been formally charged?


________________________________

________________________________

Are you related by consanguinity or affinity to any of the following :


__________________________________________________________________________

_____________________________________

Within the fourth degree (for Local Government Employees):

appointing authority or recommending authority where you will be appointed?

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?

Are you a member of any indigenous group?

Are you differently abled?

Are you a solo parent?

If YES, please specify: ____________________




________________________________

________________________________

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


________________________________

________________________________

Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:

If YES, give details:________________________________

________________________________

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?

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


________________________________

________________________________

Have you ever been convicted of any crime or violation of any law, decree, ordinance or

regulation by any court or tribunal?

TEL. NO.

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

Milagros S. Dangat, Ed. D.

Mr. Manuel M. Tulagan

Mrs. Zoila V. de Vera

ID picture taken withinthe last 6 months3.5 cm. X 4.5 cm(passport size)

Computer generatedor xerox copy of picture

is not acceptable

YES NO

YES NO

YES NOYES NO

YES NO

YES NO

YES NO

YES NOYES NOYES NO

/

/

/

/

/

/

/

/

/

/


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San Carlos CityISSUED AT

01/03/2013

ISSUED ON (mm/dd/yyyy) RIGHT THUMBMARK

SIGNATURE(Sign inside the box)

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

DATE ACCOMPLISHED

10/09/2013

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