CS Form No. 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 case/s against the person 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.
(Do not fill up. For CSC use only)
I. PERSONAL INFORMATION LINGANAY
2. SURNAME FIRST NAME
NOEL JUN
MIDDLE NAME
LAPINIG
NAME EXTENSION (JR., SR)
3. DATE OF BIRTH (mm/dd/yyyy)
7/6/1991
4. PLACE OF BIRTH
ORMOC CITY
16. CITIZENSHIP
Pls. indicate country:
If holder of dual citizenship, please indicate the details.
5. SEX
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
7. HEIGHT (m)
1.78 meters
8. WEIGHT (kg)
80
Street GUADALUPE
APARTMENT 2 House/Block/Lot No. GABUTAN COMPOUND
GUADALAJARA STREET Street GUADALUPE
Subdivision/Village CEBU CITY
Barangay CEBU
121158983589
11. PAG-IBIG ID NO.
City/Municipality
130501785823
12. PHILHEALTH NO.
06-36135446
13. SSS NO.
406 893 358 000
14. TIN NO.
Province
ZIP CODE
6000
19. TELEPHONE NO.
N/A
09202015653
20. MOBILE NO.
N/A
15. AGENCY EMPLOYEE NO.
Barangay CEBU Province 6000
N/A
10. GSIS ID NO.
GUADALAJARA STREET
ZIP CODE 18. PERMANENT ADDRESS
O
9. BLOOD TYPE
APARTMENT 2
House/Block/Lot No. GABUTAN COMPOUND Subdivision/Village CEBU CITY City/Municipality
[email protected]
21. E-MAIL ADDRESS (if any)
II. FAMILY BACKGROUND N/A
22. SPOUSE'S SURNAME
23. NAME of CHILDREN (Write full name and list all)
DATE OF BIRTH (mm/dd/yyyy)
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
LINGANAY
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
LAPINIG
N/A
N/A
FIRST NAME
LANI
N/A
N/A
MIDDLE NAME
BATO
NAME EXTENSION (JR., SR)
N/A
FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUSINESS NAME BUSINESS ADDRESS TELEPHONE NO. 24. FATHER'S SURNAME
NAME EXTENSION (JR., SR)
NOE
FIRST NAME
SILLACAY
MIDDLE NAME 25. MOTHER'S MAIDEN NAME SURNAME
(Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND 26.
LEVEL
NAME OF SCHOOL full)
(Write in
BASIC EDUCATION/DEGREE/COURSE (Write in full)
PERIOD OF ATTENDANCE
From
To
HIGHEST LEVEL/ YEAR UNITS GRADUATED EARNED (if not graduated)
SCHOLARSHIP/ ACADEMIC HONORS RECEIVED
ELEMENTARY
ISABEL ADVENTIST ELEMENTARY SCHOOL
ELEMENTARY EDUCATION
1998
2003
GRADUATED
2003
WITH HONORS
SECONDARY / VOCATIONAL
EAST VISAYAN ADVENTIST ACADEMY
SECONDARY EDUCATION
2003
2007
GRADUATED
2007
N/A
AMA COMPUTER LEARNING COLLEGE - ORMOC
COMPUTER SYSTEMS SERVICING NC II
2013
2014
GRADUATED
2014
N/A
AMA COMPUTER LEARNING COLLEGE - ORMOC
BACHELOR OF SCIENCE IN INFORMATION TECHNOLOGY
2011
2014
GRADUATED
2014
BEST IN IT CAPSTONE PROJECTS
BACHELOR OF SECONDARY EDUCATION MAJOR IN SOCIAL SCIENCES (DIPLOMA IN PROFESSIONAL EDUCATION)
2015
2016
GRADUATED
2016
N/A
COURSE COLLEGE
TRADE
SAINT PETER'S COLLEGE - ORMOC
MASTERS IN INFORMATION TECHNOLOGY
2014
2016
GRADUATED
2016
N/A
CEBU TECHNOLOGICALUNIVERSITY - MAIN CAMPUS
DOCTOR OF PHILOSOPHY IN TECHNOLOGY MANAGEMENT
2017
2017
12 UNITS
N/A
N/A
UNIVERSITY OF SAN CARLOS
JURIS DOCTOR MAJOR IN PUBLIC INTERNATIONAL LAW
2019
PRESENT
78 UNITS
N/A
N/A
ASIAN DEVELOPMENT FOUNDATION COLLEGE GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE
DATE
September 14, 2021 CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY 27.
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE BARANGAY ELIGIBILITY / DRIVER'S LICENSE
LICENSE (if applicable)
RATING (If Applicable)
DATE OF EXAMINATION / CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
82.20
09/24/2017
TACLOBAN CITY
RA 1080 LICENSED PROFESSIONAL TEACHER
NUMBER
Date of Validity
1607381
7/6/2024
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. INCLUSIVE DATES (mm/dd/yyyy)
28.
From
To
POSITION TITLE abbreviate)
DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full/Do not (Write in full/Do not abbreviate)
GOV'T SERVICE
MONTHLY SALARY
SALARY/ JOB/ PAY GRADE (if applicable)& STEP (Format "00-0")/ INCREMENT
STATUS OF APPOINTMENT (Y/ N)
1/11/2020
06/30/2021
WORDPRESS DEVELOPER
LINUXHINT, LLC
14000.00
N/A
PART-TIME
N
4/1/2020
05/30/2020
INSTRUCTOR V
AMA COMPUTER COLLEGE - CEBU
15000.00
N/A
PART-TIME
N
06/13/2016
06/13/2017
TEACHER I
DEPARTMENT OF EDUCATION
19620.00
SG 11-1
CONTRACUAL
Y
5/11/2015
05/30/2016
INSTRUCTOR II
AMA COMPUTER LEARNING CENTER - ORMOC
12000.00
N/A
CONTRACUAL
N
(Continue on separate sheet if necessary)
SIGNATURE
DATE
September 14, 2021 CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 29. NAME & ADDRESS OF ORGANIZATION
INCLUSIVE DATES (mm/dd/yyyy) To
NUMBER OF HOURS
POSITION / NATURE OF WORK
From
CENTER FOR LEGAL AID WORK - CEBU CITY
08/16/2020
06/15/2021
320.0
LEGAL RESEARCHER
RHEMA INTERNATIONAL LIVELIHOOD FOUNDATION
10/01/207
04/30/2019
200.0
IT OFFICER
(Write in full)
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED 30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS (Write in full)
INCLUSIVE DATES OF ATTENDANCE NUMBER OF HOURS
(mm/dd/yyyy) From
Type of LD ( Managerial/ Supervisory/ Technical/etc)
CONDUCTED/ SPONSORED BY (Write in full)
To
TRAINERS METHODOLOGY I TRAINING
5/12/2017
05/15/2018
264.0
TECHNICAL
DEPPARTMENT OF EDUCATION
MASS TRAINING OF TEACHERS FOR SENIOR HIGH SCHOOL TEACHERS
12/6/2016
6/21/2016
80.0
TECHNICAL
DEPPARTMENT OF EDUCATION
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION 31.
SPECIAL SKILLS and HOBBIES
32.
NON-ACADEMIC DISTINCTIONS / RECOGNITION
33.
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)
PIANO
PEOPLE'S CHOICE AWARD - PINTADOS FESTIVAL PHOTO CONTEST 2018, TACLOBAN CITY
CAMERA CLUB OF LEYTE AND SAMAR
VIOLIN
1ST PRIZE - BINAYBAYON FESTIVAL PHOTO CONTEST 2017, BAYBAY CITY, LEYTE
ISABEL PHOTOGRAPHY SOCIETY
CELLO
2ND PRIZE - BINAYBAYON FESTIVAL PHOTO CONTEST 2016, BAYBAY CITY, LEYTE
ORMOCANON PHOTOGRAPHIC SOCIETY
COMPUTER PROGRAMMING
MR. DEPED LEYTE 2016
PHILIPPINE SOCIETY FOR MUSIC EDUCATION
PHOTOGRAPHY
MR. DEPED AREA MEET 2016
PHILIPPINE SOCIETY OF INFORMATION TECHNOLOGY EDUCATORS FOUNDATION, INC.
1ST PRIZE - ROTARY CLUB OF ORMOC BAY PHOTO CONTEST 2015, ORMOC CITY 3RD PRIZE - TUGOB FESTIVAL PHOTO CONTEST 2013, ORMOC CITY (Continue on separate sheet if necessary)
SIGNATURE
DATE
September 14, 2021 CS FORM 212 (Revised 2017), Page 3 of 4
34.
Are you related by consanguinity or affinity to the appointing or recommending authority, or to the chief of bureau or office or to the person who has immediate supervision over you in the Office, Bureau or Department where you will be apppointed, a. within the third degree? b. within the fourth degree (for Local Government Unit - Career Employees)? If YES, give details: ________________________________
35.
a. Have you ever been found guilty of any administrative offense? If YES, give details: ________________________________ ________________________________ b. Have you been criminally charged before any court? If YES, give details: ________________________________ Date Filed: ________________________________ Status of Case/s:
36.
37.
38.
Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?
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 or phased out (abolition) in the public or private sector? a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)?
If YES, give details: ________________________________ ________________________________ If YES, give details: ________________________________ RESIGNATION ________________________________ If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last election to promote/actively campaign for a national or local candidate? 39.
If YES, give details:
Have you acquired the status of an immigrant or permanent resident of another country? 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?
b.
Are you a person with disability?
c.
Are you a solo parent?
If YES, please specify: If YES, please specify ID No: If YES, please specify ID No: 41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
42.
NAME
ADDRESS
TEL. NO.
JOHN GLEN D. OCANA
PALO, LEYTE
092130155671
SIDDY MAE C. MONTEMAYOR
CEBU CITY
09054590450
HAYDEE LORO - CABUQUIT
ISABEL, LEYE
09988533894
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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 administrative/criminal case/s against me.
ID picture taken within the last 6 months 4.5 cm. X 3.5 cm (passport size) Computer generated or photocopied picture is not acceptable
PHOTO
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance Government Issued ID:
PRC LICENSE
ID/License/Passport No.:
1607381
Date/Place of Issuance:
01/09/2018 - TACLOBAN CITY
SUBSCRIBED AND SWORN to before me this
Signature (Sign inside the box)
September 14, 2021 Date Accomplished
Right Thumbmark
, affiant exhibiting his/her validly issued government ID as indicated above.
Person Administering Oath CS FORM 212 (Revised 2017), Page 4 of 4
