Escolar Documentos
Profissional Documentos
Cultura Documentos
212
Revised 2017
PERSONAL DATA SHEET
WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal cas
concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No.
I. PERSONAL INFORMATION
2. SURNAME SAN JOSE
15. AGENCY EMPLOYEE NO. 01680 21. E-MAIL ADDRESS (if any) benettesj@yahoo.com.
OCCUPATION EMPLOYEE
SURNAME FRANCISCO
SECONDARY /
VOCATIONAL COLEGIO DE SAN PASCUAL BAYLON HIGH SCHOOL GRADUATE
1983 1987
N/A
SIGNATURE DATE
AL DATA SHEET
k Experience Sheet shall cause the filing of administrative/criminal case/s against the person
M. GREGORIO ST.
Street
CANUMAY WEST
Barangay
Province
1443
M. GREGORIO ST.
Street
CANUMAY WEST
Barangay
Province
245-0227
09258877892
benettesj@yahoo.com.
23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
1983
1987
1993
N/A
V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
1/1/2017 present Admin. Asst. III ( Secretary II) Council's Office 16,986.00/m
1/1/2016 12/31/2016 Admin. Asst. III ( Secretary II) Council's Office 16,512.00/m
1/1/2013 12/31/2015 Admin. Asst. III ( Secretary II) Council's Office 16,051.00/m
1/1/2012 12/31/2012 Admin. Asst. III ( Secretary II) Council's Office 14,857.00/m
SIGNATURE DATE
CS FORM 21
LICENSE (if applicable)
NUMBER Date of
Validity
(Y/ N)
Casual
Casual
Casual
Casual
Casual
Casual
Casual
Casual
Cont'l
Casual
Casual
e on separate sheet if necessary)
N/A
Strategic Planningg and Work Attitude Program 11/10/2006 16.0 Atty. Thomas
11/11/2006
I survived the Rope Challenge and Team Building 10/19/2002 4 hrs La Corona de
10/19/2002
JOGGING N/A
WATCHING MOVIES
SIGNATURE DATE
E / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
Meralco Foundation
parate sheet if necessary)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in
full)
N/A
b. within the fourth degree (for Local Government Unit - Career Employees)? YES
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:
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated
NO
NO
If YES, give details (country):
NO
NO
NO
Computer generated
or photocopied picture
is not acceptable
PHOTO
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