CS Form No. 212 Revised Personal Data Sheet JHENG
CS Form No. 212 Revised Personal Data Sheet JHENG
CS Form No. 212 Revised Personal Data Sheet JHENG
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME BAUTISTA
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARY JANE
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BAUTISTA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME EFREN QUEEN ELYSE C. BAUTISTA 08/27/2019
OCCUPATION FARMER
TELEPHONE NO.
SURNAME CELIS
ELEMENTARY BUHAYNASAPA ELEMENTARY SCHOOL PRIMARY EDUCATION 1996 2002 N/A 2002 ACHIEVER
VOCATIONAL
SECONDARY / BUHAYNASAPA NATIONAL HIGH SCHOOL HIGH SCHOOL 2002 2006 N/A 2006 N/A
BATANGAS EASTERN COLLEGES (ACADEMY) PRACTICAL NURSING 2006 2008 N/A 2008 N/A
TRADE
COLLEGE
COURSE BATANGAS EASTERN COLLEGES BACHELOR OF ELEMENTARY EDUCATION 2016 2021 N/A 2021 N/A
GRADUATE STUDIES
CREATING A VISUALLY ENGAGING VIDEO CONTENT 03/12/2022 03/12/2022 8 TECHNICAL DIWA LEARNING SYSTEMS INC.
BLOGGING AND PODCASTING AS STUDENT'S OUTPUT 02/19/2022 02/19/2022 8 TECHNICAL DIWA LEARNING SYSTEMS INC.
TEACHING ENGLISH AS A FOREIGN/SECOND LANGUAGE 06/22/2021 06/22/2021 5 TECHNICAL INSTITUTE OF GLOBAL PROFESSIONALS
TEACHER'S ROLE IN 21ST CENTURY LEARNING 06/08/2021 06/08/2021 5 TECHNICAL INSTITUTE OF GLOBAL PROFESSIONALS
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:
ROGELIO C. SEBUC TICALAN, SAN JUAN, BATANGAS 9310983418 With full and handwritten
name tag and signature over
printed name
SHARON S. MACATANGAY TICALAN, SAN JUAN, BATANGAS 09684971105
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.
LOU C. PANALIGAN
Person Administering Oath