PDS Lala
PDS Lala
PDS Lala
I. PERSONAL INFORMATION
2. SURNAME FIRST NAME MIDDLE NAME 4. DATE OF BIRTH (mm/dd/yyyy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS
M | A | D |A | L | E | L | R | A | |D
O | G | D | I | |
| O |
| G | |
| |
| |
| |
| |
| |
| |
None
| |
06/21/1968
Fem ale Widowed Separated
Igbaras, Iloilo
Male Single Married
ZIP CODE 17. TELEPHONE NO.
18. Annulled Others, specify ___________ PERMANENT ADDRESS 8. CITIZENSHIP 9. HEIGHT (m) 10. WEIGHT (kg) 11. BLOOD TYPE 12. GSIS ID NO. 13. PAG-IBIG ID NO. 14. PHILHEALTH NO. 15. SSS NO.
5029 None
20. E-MAIL ADDRESS (if any) NONE 21. CELLPHONE NO. (if any)09192249100 22. AGENCY EMPLOYEE NO.000172 23. TIN
143-259-941
25. NAME OF CHILD (Write full name and list DATE OF BIRTH (mm/dd/yyyy) all)
(Continue on separate sheet if necessary) HIGHEST GRADE/ LEVEL/ UNITS EARNED (if not graduated)
ELEMENTARY
Elem. Secondary
graduated graduated
1975 1981
1981 1985
SECONDARY / VOCATIONAL
1985
GRADUATE STUDIES
Page 1 of 4
75.51% 80.00%
V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. INCLUSIVE DATES (mm/dd/yyyy) From To POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY (Write in SALARY full)
SALARY GRADE & STEP INCREMENT (Format "000")
GOV'T SERVICE
/ / / / /
/ / / / /
/ / / / /
/ / / / /
From
The 3rd Generation Library Management: Realities and Challenges to Deal or Not to Deal 1st Digital Information and Education Seminar 2005 Athena Library Automation Software How to Establish, Manage and Maintain Archives in Different Organizations to Bridge the Gap Between Archives and Users Information Analysis Through Indexing and Abstracting of Macro/Micro Documents Technology Application for Excellence in Library Management Managerial Skills on Librarians Personnel Ethics, Effective Communication and Performance Appraisal System Basic Librarianship Skills and Values Development
10/17/2007 10/19/2007 07/28/2005 07/29/2005 02/09/2004 02/11/2004 01/28/1999 01/30/1999 10/16/1996 10/18/1996 05/29/1996 05/31/1996 12/16/1992 12/16/1996 09/19/1992 09/19/1992 06/10/1992 06/11/1992 / / / / / / / / / / / / / / / / / / / /
24 16 24 24 24 24 8 8 16
Philippine Association of Academic and Research Librarians MegaTexts Phil. Inc. Info-Ed Marketing Corporation Professional Librarians' Review Center Professional Librarians' Review Center Association of Special Libraries of the Philippines Phil. Association of State Universities and Colleges Librarians' Asso. WVSU-UNPO WVSU-ULRC
N/A
N/A
36. Are
you related by consanguinity or affinity to any of the following : YES NO If YES, give details: _________________________________ Not Applicable _____________________ YES NO If YES, give details: _________________________________ Not Applicable ________ YES NO If YES, give details: ________________________________ Not Applicable____________________ YES NO If YES, give details: ________________________________ __Not Applicable__________________ YES NO If YES, give details: ________________________________ __Not Applicable___________________ YES NO If YES, give details: ________________________________ __Not Applicable__________________ YES NO If YES, give details: ________________________________ ___Not Applicable__________________
a. 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? the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?
b. Within
37 a.
38. Have
you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?
39. 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?
40. Have
you ever been a candidate in a national or local election (except Barangay election)?
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: Are you a member of any indigenous group? Are you differently abled? Are you a solo parent?
a. b. c.
YES NO If YES, please specify: _Not Applicable _______ YES NO If YES, please specify: _Not Applicable________ YES NO If YES, please specify: _Not Applicable________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO. 3200870 local 112 3200870 local 112 3200870 local 112
ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size) Computer generated or xerox copy of picture is not acceptable
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. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential. 03249758
COMMUNITY TAX CERTIFICATE NO.
PHOTO
Iloilo City
ISSUED AT SIGNATURE (Sign inside the box)
01/15/2008
ISSUED ON (mm/dd/yyyy)
06/13/2008
DATE ACCOMPLISHED RIGHT THUMBMARK CS FORM 212 (Revised 2005), Page 4 of 4