CSC 212( Revised 2005) PDS.docx

CS FORM 212 (Revised 2005)PERSONAL DATA SHEET

Print. Legibly. Mark appropriate boxes with and use separate sheet if necessary 1. CS ID (to be filled up by CSC)

1. PERSONAL INFORMATION

2. SURNAME FIRST NAME

MIDDLE NAME TURBELA I I I I I I I I I I

JAMES I I I I I I I I I I I I I I I I I I I

ARSENIO I I I I I I I I I I I 3. NAME EXTENTION (e.g. Jr Sr)NONE

4. DATE OF BIRTH (mm/dd/yyyy)JAN 25, 197516.RESIDENTIAL ADDRESS

ZIP CODE17. TELEPHONE NOB11 L16, NJK SUBD, DAO PAGADIAN CITY, ZAMBOANGA DEL SUR

5. PLACE OF BIRTH MURCIA, NEGROS OCCIDENTAL

6. SEX/ / Male Female

7. CIVIL STATUS

/ Single Widowed / Married Separated Annulled Others, specify____

0947-392-5997

8. CITIZENSHIPFILIPINO18. PERMANENT ADDRESS

ZIP CODE

19. TELEPHONE NO.B11 L16, NJK SUBD, DAO PAGADIAN CITY, ZAMBOANGA DEL SUR

9. HEIGHT (m)1.75

10. WEIGHT (kg)87 KG

11. BLOOD TYPEO0947-392-5997

12. GSIS ID NO.20. E-MAIL ADDRESS (if any)[email protected]

13 . PAG-IBIG ID NO.21. CELLPHONE NO (if any)0947-392-5997

14. PHILHEALTH NO.14-000073858-822. AGENCY EMPLOYEE NO.

15. SSS ID NO.23. TIN938-591-224

II. FAMILY BACKGROUND

24. SPOUSES SURNAME

FIRST NAME MIDDLE NAMETURBELA

25. NAME OF CHILD (write full name and list all)DATE OF BIRTH (mm/dd/yyyy) / /

DOLORESErica Valdez Turbela 03 /16 /2002

VALDEZHans Valdez Turbela 03 /27 / 2004

OCCUPATIONNONE (HOUSEWIFE)Dave Valdez Turbela 04 / 17 /2009

EMPLOYER/BUS. NAME / /

BUSINESS ADDRESS / /

TELEPHONE NO. / /

(Continue on separate sheet if necessary) / /

26. FATHERS SURNAME FIRST NAME MIDDLE NAMETURBELA / /

VALENTIN / /

SABILLON / /

27. MOTHERS MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME / /

ARSENIO / /

NOETA / /

BULIUS (continue on separate sheet if necessary)

28. LEVEL NAME OF SCHOOL(Write in full)

DEGREE COURSE(Write in full)YEARGRADUATED(If graduated)HIGHEST GRADE/LEVEL/UNITS EARNED(If not graduated)INCLUSIVE DATESOF ATTENDANCESCOLARSHIP/ACADEMIC HONORS RECEIVED

FROMTO

ELEMENTARYLOPES JAENA ELEM SCH1989198319895TH

SECONDARYLOPES JAENA NATL HS199319891993SALUTATORIAN

VOCATIONAL/TRADE COURSE

COLLEGEWEST NEGROSCOLLEGEBACHELOR IN SECONDARY EDUCATION1997

19931997NONE

GRADUATE STUDIESPNPA

BACHELOR OF SCIENCE IN PUBLIC SAFETY200019982000NONE

(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

RATINGDATE OF

EXAMINATION

CONFERMENTPLACE OF EXAMINATION/CONFERMENTLICENSE (If any)

NUMBER

DATE OF RELEASE

NONE


V. WORK EXPERIENCE ( Include private employment, Start from your current work)

30. INCLUSIVE DATES (mm/dd/yyyy)POSITIONTITLEDEPARTMENT/AGENCY OFFICE/ COMPANY(Write in full)MONTHLYRATESALARY GRADE& STEPINCREMENT(Format 00-0)STATUS OFAPPOINTMENTGOVTSERVICE(Yes/No)

07/27/11DATEC, OPERATIONNEGROS ORIENTAL PROVINCIAL POLICE OFFICEP32,94224PERMANENTYES

12/1/0904/06/ 10CHIEF OFPOLICEDAPITAN CITY, ZAMBOANGA DEL NORTEP28,00024PERMANENTYES

10/28/0901/04/10C, INTEL BRANCHZAMBOANGA DEL NORTE PROVINCIAL POLICE OFFICEP28,00024PERMANENTYES

07/13/09 01/04/10 C, INVESTIGATIONZAMBOANGA DEL NORTE PROVINCIAL POLICE OFFICEP24,00024PERMANENTYES

02/15/08 07/13/09 CHIEF OFPOLICESINDANGAN, ZAMBOANGA DEL NORTEP24,00024PERMANENTYES

06/01/04 02/11/08COMPANY COMMANDERIST COMPANY, REGIONAL MOBILE GROUP, REGION 9P22,00023PERMANENTYES

11/01/00 05/31/02PCP COMMANDERPASAY CITY, NCRP19,00022PERMANENTYES

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CS FORM 212 (Revised 2005), Page 2 of 4

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

32. NAME & ADDRESS OF ORGANIZATION(Write in full)INCLUSIVE DATES(mm/dd/yyyyNUMBERSOF HOURSPOSITION / NATURE OF WORK

FromTo

NONE


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

32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES(Write in full)INCLUSIVE DATESOF ATTENDANCE(mm/dd/yyyy)NUMBER OF HOURS

CONDUCTED/SPONSORED BY(Write null)

DRUG INVESTIGATION CRUSH COURSEDEC 26JAN 15, 2001160DEP CENTER TRAINING SCHOOL, CAMP CRAME

SPECIAL POLICE TACTICS ORIENTATION COURSEMAY 05JUNE 3, 1999160PHILIPPINE PUBLIC SAFETY COLLEGE

VITAL INSTALLATION SECURITY COURSESEPT 8 SEPT 26,200840ATAP

Human Rights gender and Law enforcement courseSept 28Sept 30,201024United Nation


VIII. OTHER INFORMATION

33. SPECIAL SKILLS / HOBBIES

34. NON-ACADEMIC DISTINCTIONS / RECOGNITION(Write in full)35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION(Write in full)

PLAYING BASKETBALLNONE


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 of person who has immediate supervision over you in the Office, Bureau or Department where you will be appointed?

b. Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?

x YES / NO If YES, give details:

YES / NO If YES, give details:

37. a. Have you ever been formally charged?

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

/ YES / NOIf YES, give details:.

YES / NO If YES, give details:

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal? YES / NOIf YES, give details

39. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the role, dismissal, termination, end of term, finished contract, AWOL, or phased out, in the public or private sector? YES / NOIf YES, give details

40. Have you ever been a candidate in a national or local election (except Barangay election)? YES / NOIf YES, give details

41. Pursuant to (a) Indigenous Peoples 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 differently abled? c. Are you a solo parent? YES / NOIf YES, give details ___________________ YES / NOIf YES, give details ___________________ YES / NOIf YES, give details ___________________

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

NAMEADDRESSTEL NO.

ID PICTURE TAKEN WITHINTHE LAST 6 MONTHS3.5 CM X 4.5 CM(PASSPORT SIZE)

Computer generatedor Xerox copy pictureis acceptable

SUPT GLENN DULAWANDAPITAN CITY09054249348

SUPT RANDOLF BALONGLONGDUMAGUETE CITY09213519115

SUPT ROY BAHIANPAGADIAN CITY09213080848

43. I declare under oath that this Personal Date Sheet has been accomplished by me, correct and complete statement pursuant to the provisions of pertinent laws, rules land regulation of the Republic of the Philippines.

I also authorize the agency head / authorized representative to verify / verify validate the contents stated herein. I trust that this information shall remain confidential.

PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT. SIGNATURE (Sign inside the box). ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED

RIGHT THUMB MARK

CS FORM 212 (Revised 2005) Page 4 of 4

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CSC 212( Revised 2005) PDS.docx