CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes

with "P " and use separate sheet if necessary.

1. CS ID No.

(to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME FIRST NAME MIDDLE NAME

MENDOZA ALVIN TIGAS

03/11/1984 3. NAME EXTENSION (e.g. Jr., Sr.) 16. RESIDENTIAL ADDRESS MABOLO,

4. DATE OF BIRTH (mm/dd/yyyy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS

CITY

OF

MALOLOS,

STA. MARIA, BULACAN q Single q Widowed q Married q Separated q Annulled q Others, specify FILIPINO 5'7" 58 KG. TYPE O
ZIP CODE 19. TELEPHONE NO.

BULACAN 3000

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.

Male
___________

ZIP CODE

17. TELEPHONE NO. 18. PERMANENT ADDRESS

MABOLO, BULACAN 3000

ale Fem
CITY OF MALOLOS,

robbed_05@yahoo.com 20. E-MAIL ADDRESS (if any)

21. CELLPHONE NO. (if any)0915-982-23-84 22. AGENCY EMPLOYEE NO. 23. TIN

239-912-718
25. NAME OF CHILD (Write full name and list DATE OF BIRTH (mm/dd/yyyy) all)

II. FAMILY BACKGROUND

24.SPOUSE'S SURNAME FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUS. NAME BUSINESS ADDRESS TELEPHONE NO. (Continue on separate sheet if necessary) 26. FATHER'S SURNAME FIRST NAME MIDDLE NAME

NA

NA

/ / / / / / /

/ / / / / / /

MENDOZA

NESTOR IGNACIO TIGAS MERCELITA CRUZ

YEAR GRADUATE D DEGREE COURSE (Write in full)

02/26/1960 / / / /

27. MOTHER'S MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME

12/18/1960 (Continue on separate sheet if necessary) HIGHEST GRADE/ LEVEL/ UNITS EARNED (if not graduated)

III. EDUCATIONAL BACKGROUND

28. LEVEL NAME OF SCHOOL (Write in full)

INCLUSIVE DATES OF ATTENDANCE From To

SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

ELEMENTARY

SAN GABRIEL ELEMENTARY SCHOOL

SECONDARY / VOCATIONAL

SACRED HEART ACADEMY

(if 1997 graduated )

1990
1997

1997
ACADEMIC EXCELLENCE

2001

2001

With Honor

NA
COLLEGE TRADE COURSE

BULACAN STATE UNIVERSITY

BSED

2005

2001

2005

Cum Laude

SOCIAL STUDIES GRADUATE STUDIES

BULACAN STATE UNIVERSITY

MAE
SOCIAL STUDIES

9 UNITS

PRESEN T

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

IV. CIVIL SERVICE ELIGIBILITY

29. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE RATING DATE OF EXAMINATION / CONFERMENT PLACE OF EXAMINATION / CONFERMENT LICENSE (if applicable) NUMBER DATE OF RELEASE

PD 907-HONOR GRADUATE
LICENSURE EXAMINATION FOR TEACHERS 80.00% 08/14/2005 CENTRAL COLLEGES OF THE PHILIPPINES 0879538

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. INCLUSIVE DATES POSITION TITLE (mm/dd/yyyy) From To (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)
MONTHLY SALARY
SALARY GRADE & STATUS OF STEP APPOINTMEN INCREMENT T (Format "000")
CONTRACTUAL

GOV'T SERVICE

06/01/2011 PRESENT 06/13/2010

HIGH SCHOOL TEACHER COLLEGE INSTRUCTOR HIGH SCHOOL TEACHER PRJECT CONSULTANT

CONG. TEODULO NATIVIDAD NATIONAL HIGH SCHOOL BULACAN STATE UNIVERSITY HOLY SPIRIT ACADEMY OF MALOLOS DBP-DCI

12,000 10,000 16,000 12,000

No) YES

(Yes /

PRESENT

PART-TIME PERMANEN T
CONTRACTUAL

YES NO NO

6/1/2006

3/30/2010 ###

06/01/2005

(Continue on separate sheet if necessary) CS FORM 212 (Revised 2005), Page 2 of 4

30.

INCLUSIVE DATES POSITION TITLE (mm/dd/yyyy) From To (Write in full)

DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full)

MONTHLY SALARY

SALARY GRADE & STATUS OF STEP APPOINTMEN INCREMENT T (Format "000")

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

INCLUSIVE DATES 31. NAME & ADDRESS OF ORGANIZATION (Write in full) (mm/dd/yyyy) From To / / / / / / / / / / / / / / / / / / / / NUMBER OF HOURS POSITION / NATURE OF WORK

NA

(Continue on separate sheet if necessary)

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

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

7TH LECTURE SERIES FOR BULACAN STUDIES JOSE RIZAL: BACK TO THE FUTURE

01/23/2011 02/23/2011 09/16/2010 06/04/2010 06/02/2010 06/02/2010 02/20/2010

8 8 16
8

CENTER FOR BULACAN STUDIES CENTER FOR BULACAN STUDIES DC-SUC III/CIRPS PHOENIX PUBLISHING HOUSE, INC. JO-ES PUBLISHING HOUSE, INC. REX BOOKSTORE THE LIBRARY PUBLISHING HOUSE, INC. CEAP REGION III KAPANALIG-PAMAHALAANG BAYAN NG OBANDO PHOENIX PUBLISHING HOUSE, INC. PHOENIX PUBLISHING HOUSE, INC. UP SCHOOL OF ECONOMICS (DILIMAN), UP ECONOMICS SOCIETY, AND NEDA

STRENGTHENING THE RESEARCH CAPABILITIES OF SUC'S IN REGION III

09/17/2010 / / / / / / / /

CRITICAL THINKING TEACHING STRATEGIES ENGLISH PROFICIENCY

THE ART OF QUESTIONING

4 4 8
8 24 8 8 8

08/19/2009 / / 2010 ELECTIONS: A CALL FOR ETHICAL LEADERSHIP AND ENGAGED CITEZENSHIP 11/06/2010 KAPANALIG: LEADERSHIP AND VALUES ORIENTATION SEMINAR 11/08/2009 / / / /

RUBRIC METHOD OF EVALUATION

7/25/2009

06/05/2009 ENHANCING WRITTEN AND ORAL COMMUNICATION SKILLS

09/06/2008 / / NATIONAL YOUTH CONGRESS: "NO VACNACY: THE ECONOMICS OF EDUCATION / / / / / / / / / / / /

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION: 33. SPECIAL SKILLS / HOBBIES: 34. (Write in full) 35.

MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full) SAMAHANG PANGKASAYSAYAN NG BULACAN NATIONAL ORGANIZATIION OF PROFESSIONAL TEACHERS GENDER AND DEVELOPMENT EXTENSION SERVICES (BULSU)

(Continue on separate sheet if necessary) CS FORM 212 (Revised 2005), Page 3 of 4

36. Are

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

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.

Have you ever been formally charged?

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

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.

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS

MR. ALLAN ALBA

DR. REYNALDO NAGUIT

CITY OF MALOLOS, BULACAN BULACAN, BULACAN STA. MARIA BULACAN

YES YES YES YES YES YES YES YES YES YES
If YES, give details: ____________________________________ _ ____________________________________ _ ____________________________________ _ If YES, give details: ____________________________________ _ ____________________________________ _ ____________________________________ If _ YES, give details: ________________________________ ________________________________ If YES, give details: ________________________________ ________________________________ If YES, give details: ________________________________ ________________________________ If YES, give details: ________________________________ ________________________________ If YES, give details: ________________________________ ________________________________
TEL. NO. O9053006591 O9228640956
O9063339658 Computer generated or xerox copy of picture is not acceptable ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size)

If YES, please specify: ____________________ If YES, please specify: ____________________ If YES, please specify: ____________________

MS. RIA IGNACIO

43. 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. 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.

ALVIN T. MENDOZA
ISSUED AT SIGNATURE (Sign inside the box)

06/02/2011
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

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