ADS Nov. 2021 PDF
ADS Nov. 2021 PDF
ADS Nov. 2021 PDF
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME SUAREZ
NAME EXTENSION (JR., SR)
FIRST NAME ALDRICH
15. AGENCY EMPLOYEE NO. 4204570 21. E-MAIL ADDRESS (if any)
OCCUPATION TEACHING
SURNAME DOMINGO
ELEMENTARY SHAMROCK ELEMENTARY SCHOOL ELEMENTARY 2001 2007 GRADUATED 2007 N/A
CRIMINOLOGIST LICENSURE EXAMINATION 86.40% 10/23/2015 BAGUIO CITY, BENGUET 0124778 5/8/2022
PD 907 HONOR GRADUATE ELIGIBILITY N/A 04/14/2016 LAOAG CITY, ILOCOS NORTE 100101160344 N/A
CAREER SERVICE SUBPROFESSIONAL ELIGIBILITY 81.88% 10/26/2014 LAOAG CITY, ILOCOS NORTE 602072 N/A
6/6/2016 03/31/2017 INSTRUCTOR DATA CENTER COLLEGE OF THE PHILIPPINES 10, 000 N/A PART TIME NO
5 DAY INSET- OPEN BROADCAST SYSTEM 12/14/2020 12/18/2020 40 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL
WEBINAR: TEACHING COMPREHENSION THROUGH NARRATIVE TEXTS 07/24/2020 07/24/2020 4.0 TECHNICAL VIBAL GROUP
WEBINAR: TAILOR-FITTING THE LEARNING MODALITIES FOR THE YOUNG JUANS 07/14/2020 07/14/2020 4.0 TECHNICAL VIBAL GROUP
ICT WEBINAR SERIES: DEVELOPMENT OF INTERACTIVE E-BOOK 06/17/2020 06/17/2020 8.0 TECHNICAL SCHOOLS DIVISION OFFICE OF ILOCOS NORTE
SCHOOL IN-SERVICE TRAINING & GAD SEMINAR 10/21/2019 10/25/2019 40.0 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL
SEMINAR ON DEVELOPING INTERACTIVE E-BOOK USING KOTOBEE AUTHOR SOFTWARE 06/15/2020 06/15/2020 8.0 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL
CAPABILITY BUILDING 12/13/2019 12/14/2019 16.0 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL
COMPUTER LITERATE
COOKING
✘
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
by any court or tribunal? YES ✘ NO
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:
MERINA G. RAMOS DUMALNEG NATIONAL HIGH SCHOOL With full and handwritten
name tag and signature over
DATA CENTER COLLEGE OF THE printed name
MATTHEW P. LANGBIS
PHILIPPINES Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein.
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.