pds_101113_tesda

2. SURNAME

FIRST NAME

MIDDLE NAME

4.

5. PLACE OF BIRTH

6. SEX

17. TELEPHONE NO.

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.

24. SPOUSE'S SURNAME

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

26.

27.

From To

1981 June 1976 March 1981 Third Honors

1985 June 1981 April 1985 Valedictorian

N/A

1989 June 1985 April 1989

1999 Jun-90 Apr-99 N/A

Jun-11 to date

Page 1 of 4

FRANCISCO DATE OF BIRTH (mm/dd/yyyy)

DEPARTMENT OF EDUCATION

LUIS

RAMOS

GOVERNMENT EMPLOYEE

CIVIL STATUS

(Continue on separate sheet if necessary)

10/15/1994

[email protected]

25. NAME OF CHILD (Write full name and list all)

06/25/2007

20. E-MAIL ADDRESS (if any)

040790006

LEVELDEGREE COURSE

(Write in full)

YEAR

GRADUATED

(if graduated)

LANCE LUIGI S. FRANCISCO

MIDDLE NAME FAVILA

GONZAGA

MANGA

CM-431-1181

CITY DIVISION OFFICE, PUERTO PRINCESA CITY

048-434-9787


09-000059021-4

N/A

22. AGENCY EMPLOYEE NO.

23. TIN

LARA LOUISA S. FRANCISCO

132-791-270

F | R | A | N | C | I | S | C | 0 | | | | | | | | | | | | | | | | | | | | | | |

G | I | N | A | I | | | | | | | | | | | | | | | | | | | | | | | | | | |

5300

Mitra Rd., Santa Monica, Puerto Princesa City

1.60m

Mitra Rd., Santa Monica, Puerto Princesa CityBalabac, Palawan

16. RESIDENTIAL ADDRESS

3. NAME EXTENSION (e.g. Jr., Sr.)

MOTHER'S MAIDEN NAME

SURNAME

FATHER'S SURNAME

FIRST NAME MARGARITA

FIRST NAME ARTEMIO

MIDDLE NAME

SEGOVIA

"O"

5300

NAME OF SCHOOL

(Write in full)

PNAC-Bayanihan High School N/A

Calasaguen Elementary School N/AGraduated

Graduated

HIGHEST GRADE/

LEVEL/

UNITS EARNED

(if not graduated)

12/151968

0917849562021. CELLPHONE NO. (if any)

ZIP CODE

Filipino

19. TELEPHONE NO.

n/a

58

PERSONAL DATA SHEET

CS FORM 212 (Revised 2005)

1. CS ID No. (to be filled up by CSC)Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary.


53 units

SCHOLARSHIP/

ACADEMIC HONORS

RECEIVED

INCLUSIVE DATES OF

ATTENDANCE

WESTERN PHILIPPINE UNIVERSITY

ZIP CODE

18. PERMANENT ADDRESS

II. FAMILY BACKGROUND

III. EDUCATIONAL BACKGROUND

COLLEGE

28.

N/A

040207285911

PALAWAN STATE UNIVERSITY

PALAWAN NATIONAL AGRICULTURAL

COLLEGE (NOW WESTERN PHIL. UNIV.)N/ABSAgEducation

I. PERSONAL INFORMATION

7.

S | E | G | O | V | I | A | | | | | | | | | | | | | | | | | | | | | | | | |

DATE OF BIRTH (mm/dd/yyyy)

GRADUATE STUDIES

ELEMENTARY

SECONDARY

VOCATIONAL /

TRADE COURSEN/A

MPA

PhD in Rural Devt

N/A

Annulled

Others, specify ___________

Single

Married

Widowed

Separated

Male Fem ale

mailto:[email protected]

29.

NUMBERDATE OF

RELEASE

81.29% N/A N/A

81.79% N/A N/A

76.88% 1036900 10/23/09

On Process

30.

To

to date 17,225 Permanent Yes

10/31/11 17,003 Permanent Yes






06/30/07 10971 Permanent Yes













2,752 Permanent Yes





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

07/01/09 AR Program TechnologistDEPARTMENT OF AGRARIAN

REFORM

06/01/11

06/24/10

AR Program TechnologistDEPARTMENT OF AGRARIAN

REFORM

07/01/07

07/01/08

11/01/08

11/01/11 AR Program TechnologistDEPARTMENT OF AGRARIAN

REFORM


REFORM

RATING

IV. CIVIL SERVICE ELIGIBILITY

11/01/05

AR Program Technologist


REFORM


REFORM


DEPARTMENT OF AGRARIAN

REFORM

11/01/99


REFORM

CAREER SERVICE/ RA 1080 (BOARD/ BAR)

UNDER SPECIAL LAWS/ CES/ CSEE

DATE OF

EXAMINATION /

CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

LICENSE (if applicable)

11/02/02 AR Program Technologist

Career Service Professional




REFORM

07/01/01

09/26/90

01/01/97

11/01/96

11/01/97

01/01/94

01/01/00

11/12/89

01/01/96

11/01/93

01/01/95

04/01/91



04/01/91

MONTHLY

SALARY


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

10/20/89

08/21/89

DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full)

POSITION TITLE

(Write in full)

INCLUSIVE DATES

(mm/dd/yyyy)

From

12/10/1989



REFORM


01/01/2013License Agriculturist


REFORM


REFORM

Career Service Professional

Professional Board Examination for Teachers

10/29/1989

11/27/1994

Puerto Princesa City




REFORM


REFORM


STATUS OF

APPOINTMENT

GOV'T

SERVICE

(Yes / No)

SALARY GRADE

& STEP

INCREMENT

(Format "00-0")

DEPARTMENT OF EDUCATION


Elementary Grades Teacher

Elementary Grades Teacher


REFORM

Manila


REFORM


REFORM


REFORM


REFORM


REFORM


REFORM

Elementary Grades TeacherDEPARTMENT OF AGRARIAN

REFORM


REFORM

Assistant Statistician

Clerk II

Assistant Statistician


DEPARTMENTOF EDUCATION

From To

Jan 01, 2012 12/31/2013

/ / / /

From To

06/12/2013 09/20/2013 800

07/22/2013 07/26/2013 40

04/10/2013 04/12/2013 24

08/16/2012 08/17/2012 16

09/20/2012 09/22/2012 24

05/28/2012 05/30/2012 24

05/26/2012 05/26/2012 8

09/30/2010 10/02/2010 24

10/20/2009 10/23/2009 32

08/06/2009 08/07/2009 16

04/17/2009 04/17/2009 8

08/28/2007 08/30/2007 24

09/11/2005 09/16/2005 48

09/04/2005 09/09/2005 48

33. SPECIAL SKILLS / HOBBIES: 34. 35.

PCU Accredited Trainor with CDA

DAR Palawan Accredited with Trainor

Seminar on Philippine Cooperative Code of 2008 RA 9250 and

Sunflower ProductionPalawan Coop Union

Training Facilitation Seminar

Orientation cum Hands-on Activity on Integrated M & E Database

System for ARISP IIIDAR-ARISP II


MEMBERSHIP IN

ASSOCIATION/ORGANIZATION

(Write in full)

Farmer's Field School-100 days training on Organic Vegetable

Production Training and DemoDA-ROS and DAR

Basic Cooperative Course Palawan Coop Union

PCIC Orientation cum PBD Conference and ARCOD Refresher

CourseDARPO, Palawan

DAREA

Re-Tolling of Trainers' on Training Facilitation Palawan Coop Union

Training of Trainers on Cooperative & Effective Training

ManagementDAR and CDA

Symposium - Workshop on Organic Farming and Climate Change

Adaptability Western Philippines University

DARCO

Enterprise-based Agrarian Reform Community Development (E-

ARCOD)

Palawan Coop Union

NUMBER OF

HOURSPOSITION / NATURE OF WORK

INCLUSIVE DATES OF ATTENDANCE

(mm/dd/yyyy)32. CONDUCTED/ SPONSORED BY

(Write in full)

PPC-Calvary Baptist Church

PPC-Calvary Baptist Academy


Exemplary Performance in the accomplishment of PBD Target

for 2005Community Organizer

ENTREFARM-based Training for Selected [email protected]

Assisted Coop, DFs, Project Development Officers and Provincial

Point Persons

Course on Business Management, Record Keeping and

Project DocumentationTraining Facilitator DARPEMCO

VIII. OTHER INFORMATION

Development FacilitatorLecturer/Resource Speaker on Leadership and Maintenance-

Financial Management Workshop for 2006

Computer Literate Certificate of Appreciation,as Resource Person on Training

Certificate of Appreciation, Exemplary Performance as

PARCOOM Secretariat

Certificate of Recognition, Exemplary Performance in DAR-

ARISP II Project

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)



Speaker/Resource Person on Coop Level Planning and

Budgeting/Financial and Internal Control

LTI Task Force Member on February 2007

Speaker in Cooperativism on March 2009

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

TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES

(Write in full)

NUMBER OF

HOURS

Treasurer

Member, School Board

31.

VII. TRAINING PROGRAMS and SCHOLARSHIP GRANTS RECEIVED (Start from the most recent training.)

NAME & ADDRESS OF ORGANIZATION

(Write in full)

INCLUSIVE DATES

(mm/dd/yyyy)

Bookkeeping and Accounting CCDC-Puerto Princesa City

DARCO

Training on Coop Internal Audit System and Business Operations

ReviewDARPO

Enhancement Training Facilitation on Rules Formulation,

Parliamentary Procedure, Conflict Management, Records

Management and Audit Management

DAR Region-IVB

36.

a.

b.

37

38.

39.

40.

41.

a.

b.

c.

42.

NAME ADDRESS

DARPO Palawan

Santa Monica, PPCity

DARPO Palawan

PHOTO

08412850

COMMUNITY TAX CERTIFICATE NO.


ISSUED AT

05/27/2013

ISSUED ON (mm/dd/yyyy) RIGHT THUMBMARK

9213197465

9178494042

Contact No.

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

Conrado S. Guevarra

Ptr. Augusto Y. Oyos

Ricardo SA Francisco

9178496061

If YES, please specify: ____________________

If YES, give details:

________________________________

________________________________

Have you ever been a candidate in a national or local election (except Barangay election)? No


________________________________

________________________________

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 solo parent?

If YES, please specify: ____________________

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.


_____________________________________

_____________________________________

_____________________________________

a. Have you ever been formally charged?

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


________________________________

________________________________


________________________________

________________________________

Have you ever been convicted of any crime or violation of any law, decree, ordinance or

regulation by any court or tribunal?

SIGNATURE

43.


DATE ACCOMPLISHED

I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust

that this information shall remain confidential.

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


_____________________________________

_____________________________________

_____________________________________

Within the fourth degree (for Local Government Employees):

appointing authority or recommending authority where you will be appointed?

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?

Are you a member of any indigenous group?

Are you differently abled?


________________________________

________________________________

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? No

If YES, please specify:

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

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

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