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 D | O | O | N | G| | | | | | | | | | | | | | | | |
FIRST NAME C | H |A | R | I |S | | J | O | Y | | | | | | | | | | | |
MIDDLE NAME R | E | D | O | N | D | O | | | | | 3. NAME| EXTENSION
| (e.g.
| Jr., Sr.)| | N/A| | | |
4. DATE OF BIRTH (mm/dd/yyyy) 04/07/1988 16. RESIDENTIAL ADDRESS

5. PLACE OF BIRTH MAKILALA, COTABATO POBLACION , MAKILALA, COTABATO

6. SEX Male Female
Single Widowed
7. CIVIL STATUS 9401
Separated ZIP CODE
Married
Others, specify ___________17. TELEPHONE NO. NONE
Annulled 18. PERMANENT ADDRESS

8. CITIZENSHIP FILIPINO Sinsuat Extension, Kidapawan City

9. HEIGHT (m) 5'2
10. WEIGHT (kg) 65 Kilos ZIP CODE 9401
11. BLOOD TYPE A+ 19. TELEPHONE NO. none
12. GSIS ID NO. NONE 20. E-MAIL ADDRESS (if any) [email protected]
13. PAG-IBIG ID NO. 912144052686 21. CELLPHONE NO. (if any) 09204693213
14. PHILHEALTH NO. 160252644919 22. AGENCY EMPLOYEE NO.

15. SSS NO. 0930043603 23. TIN 269-573-058

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

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME / /
BUSINESS ADDRESS / /
TELEPHONE NO. / /
(Continue on separate sheet if necessary) / /
26. FATHER'S SURNAME DOONG / /
FIRST NAME REYNALDO / /
MIDDLE NAME del LEON / /
27. MOTHER'S MAIDEN NAME / /
SURNAME DOONG / /
FIRST NAME MARIA CRISTINA / /
MIDDLE NAME REDONDO 09215691606 (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND YEAR

GRADUATED
HIGHEST GRADE/ INCLUSIVE DATES OF
28. NAME OF SCHOOL DEGREE COURSE SCHOLARSHIP/
LEVEL/ ATTENDANCE
LEVEL (Write in (Write in full) UNITS EARNED
ACADEMIC HONORS
full) (if not graduated) From To RECEIVED
(if
graduated) Elementary
ELEMENTARY Buli Elementary School NONE 2001 1996 2001 NONE
Graduate
High School Class
SECONDARY Notre Dame of Tacurong for Boys NONE 2005 2001 2005
Graduate Salutatorian
VOCATIONAL /
Certificate in Diploma in
University of the Philippines- Community Health 2008 Community Jun-05 Jun-05 N/A
Manila Works
TRADE Health Works
COURSE
COLLEGE

Bachelor of College Best in Thesis

Colegio de Kidapawan Science in Nursing 2010 2008 2010 Writing
Graduate

GRADUATE STUDIES Post Graduate

Notre Dame of Dadiangas University-Notre
Dame of Kidapawan College
Masters of Arts in N/A Final Defense 2009 2016 N/A
Nursing

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

DOONG, CHARIS JOY R.
IV. CIVIL SERVICE ELIGIBILITY
29. DATE OF LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE NUMBER DATE OF
CONFERMENT
RELEASE
December
Philippine Nursing Licensure Exam 80.80% Ateneo De Davao University, Davao City 0431254 04-30-2007
2006

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE
30. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY GRADE
(mm/dd/yyyy) MONTHLY & STEP STATUS OF
SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To
(Yes / No)
CLINIC MANAGER DOONG MATERNITY CLINIC NO

MAKILALA INSTITUTE OF SCIENCE

CLINICAL INSTRUCTOR 3 YES
AND TECHNOLOGY
UNIVERSITY OF SOUTHERN
INSTRUCTOR 2 YES
MINDANAO

CLINICAL INSTRUCTOR 3 COLEGIO DE KIDAPAWAN NO

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 2 of 4

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

Cotabato Provincial Hospital, Amas, Kidapawan City 06/02/2008 12/31/2008 / / Nurse Volunteer

Cotabato Provincial Hospital, Amas, Kidapawan City 01/01/2010 07/31/2010 / / Nurse Volunteer

Makilala Institute of Science and Technology 12/01/2015 10/31/2016 / / Clinical Instructor

/ / / / / /

/ / / / / /
(Continue on separate sheet if necessary)

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

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION: ASSOCIATION/ORGANIZATION
33. SPECIAL SKILLS / HOBBIES: 34. 35.
(Write in full)
(Write in full)
Cooking, Computer Literate NONE Philippine Nurses Association Inc.

Philippine Association of Diabetes

Educators
Operating Room Nurses
Association of the Philippines
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4

ALVARADO, RIGOR K.
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 If YES, give details:
has immediate supervision over you in the Office, Bureau or Department where you will be _____________________________________
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.

Ser Rosenkranz Espartero, RN, MAN Notre Dame of Dadiangas University 9326027387
ID picture taken within
the last 6 months
Leah Abedin, CPA Commission on Audit 9176322188 3.5 cm. X 4.5 cm
(passport size)
Leila Solis, RN, RM Cotabato Provincial Hospital 09993935081
Computer generated
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and or xerox copy of picture
is not acceptable
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. PHOTO

COMMUNITY TAX CERTIFICATE NO.

Kidapawan City
ISSUED AT SIGNATURE (Sign inside the box)

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

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

ALVARADO, RIGOR K.