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    Job PDS

    Uploaded by

    acelaerden
    This personal data sheet provides personal and background information for Maycil Ambag Farillon. It includes her personal details like name, date of birth, place of birth, address and contact information. It also lists her educational background including attending Tapaz Central School, San Nicolas National High School, University of San Agustin and University of Iloilo. Her work experience, training programs, organizations involved in and references are also included in the document.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Job PDS

    Uploaded by

    acelaerden
    78 views4 pages
    This personal data sheet provides personal and background information for Maycil Ambag Farillon. It includes her personal details like name, date of birth, place of birth, address and contact information. It also lists her educational background including attending Tapaz Central School, San Nicolas National High School, University of San Agustin and University of Iloilo. Her work experience, training programs, organizations involved in and references are also included in the document.

    Original Description:

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    Original Title

    20150703-JOB-PDS

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    This personal data sheet provides personal and background information for Maycil Ambag Farillon. It includes her personal details like name, date of birth, place of birth, address and contact information. It also lists her educational background including attending Tapaz Central School, San Nicolas National High School, University of San Agustin and University of Iloilo. Her work experience, training programs, organizations involved in and references are also included in the document.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    78 views4 pages

    Job PDS

    Uploaded by

    acelaerden
    This personal data sheet provides personal and background information for Maycil Ambag Farillon. It includes her personal details like name, date of birth, place of birth, address and contact information. It also lists her educational background including attending Tapaz Central School, San Nicolas National High School, University of San Agustin and University of Iloilo. Her work experience, training programs, organizations involved in and references are also included in the document.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 4

    PERSONAL DATA SHEET

    1. GSIS Emp. No.

    PDS as of

    I. PERSONAL INFORMATION
    AMBAG

    2. SURNAME
    FIRST NAME

    MAYCIL

    MIDDLE NAME

    FARILLON
    01/27/1985

    4. DATE OF BIRTH (mm/dd/yyyy)


    PLACE OF BIRTH (Town/City
    5. and Province

    TAPAZ, CAPIZ

    6. SEX (MALE/FEMALE)

    FEMALE

    7. CIVIL STATUS (Single,


    Married, Widowed,
    Separated, Annuled, others
    pls specify.

    SINGLE

    N/A

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


    16. RESIDENTIAL ADDRESS

    #30 LAPU-LAPU STREET, BRGY. LOURDES, CITY OF SAN


    FERNANDO PAMPANGA
    ZIP CODE

    2000
    N/A

    17. TELEPHONE NO.


    18. PERMANENT ADDRESS

    8. CITIZENSHIP

    FILIPINO

    9. HEIGHT (m)

    4'11

    10. WEIGHT (kg)

    60KG

    11. BLOOD TYPE

    "O"

    #30 LAPU-LAPU STREET, BRGY. LOURDES, CITY OF SAN


    FERNANDO PAMPANGA
    ZIP CODE

    2000

    19. TELEPHONE NO.

    N/A

    12. GSIS ID NO.

    20. E-MAIL ADDRESS (if any)

    [email protected]

    13. GSIS POLICY NO.

    21. CELLPHONE NO. (if any)

    09292658178

    14. PAG-IBIG ID NO.

    121086287970

    22. SSS NO.

    0724516825

    15. PHILHEALTH NO.

    110252291423

    23. TIN

    286208398

    II. FAMILY BACKGROUND


    24. SPOUSE'S SURNAME

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

    N/A

    FIRST NAMEN/A
    MIDDLE NA

    DATE OF BIRTH (mm/dd/yyyy)

    N/A

    N/A

    N/A

    N/A

    N/A

    OCCUPATION

    N/A

    EMPLOYER/BUS. NAME

    N/A

    BUSINESS ADDRESS

    N/A

    TELEPHONE NO.

    N/A
    (Continue on separate sheet if necessary)

    26. FATHER'S SURNAME

    AMBAG

    FIRST NAME

    ANDRONICO

    MIDDLE NAME

    GINER

    27. MOTHER'S MAIDEN NAME


    SURNAME

    FARILLON

    FIRST NAME

    MELBA

    MIDDLE NAME

    DEJONGGOY

    (Continue on separate sheet if necessary)

    III. EDUCATIONAL BACKGROUND


    28.

    DATE
    GRADUATED

    NAME OF SCHOOL
    LEVEL

    (Write in

    HIGHEST GRADE/
    LEVEL/
    UNITS EARNED
    (if not graduated)

    DEGREE COURSE
    (Write in full)

    full)

    INCLUSIVE DATES OF
    ATTENDANCE
    From

    To

    ELEMENTARY

    TAPAZ CENTRAL SCHOOL

    ELEMENTARY

    (if03/30/96
    graduated)

    1991

    1996

    VOCATIONAL
    SECONDARY /

    SAN NICOLAS NATIONAL HIGH SCHOOL

    HIGH SCHOOL

    03/30/01

    1996

    2001

    COLLEGE
    TRADE COURSE

    UNIVERSITY OF SAN AGUSTIN

    BACHELOR OF
    ARTS

    04/30/05

    2001

    2005

    2005

    2009

    2011

    2012

    GRADUATE STUDIES

    UNIVERSITY OF ILOILO

    BACHELOR OF
    04/30/09
    LAWS
    BACHELOR OF
    SECONDARY
    04/30/12
    EDUCATION
    (Continue
    on separate sheet if necessary)

    GSIS PDS Form Page 1 of 4

    SCHOLARSHIP/
    ACADEMIC HONORS
    RECEIVED

    IV. CIVIL SERVICE ELIGIBILITY


    29.

    CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER


    SPECIAL LAWS/ CES/ CSEE

    RATING

    DATE OF
    EXAMINATION /
    CONFERMENT

    LICENSE (if applicable)


    PLACE OF EXAMINATION / CONFERMENT

    NUMBER

    DATE OF
    RELEASE

    (Continue on separate sheet if necessary)

    V. WORK EXPERIENCE (Include private employment. Start from your current work)
    30.

    INCLUSIVE DATES
    (mm/dd/yyyy)
    From

    To

    POSITION TITLE

    DEPARTMENT / AGENCY / OFFICE / COMPANY


    (Write in full)

    (Write in full)

    GOV'T
    SERVICE
    MONTHLY
    SALARY

    SALARY GRADE
    & STEP
    INCREMENT
    (Format "00-0")

    STATUS OF
    APPOINTMENT
    (Yes /
    No)

    (Continue on separate sheet if necessary)


    GSIS PDS Form Page 2 of 4

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


    INCLUSIVE DATES
    31. NAME & ADDRESS OF ORGANIZATION
    (mm/dd/yyyy)

    (Write in full)
    From

    GIRL SCOUT OF THE PHILIPPINES

    06/01/01

    IN SOLIDUM FRASORITY

    NUMBER OF
    HOURS

    POSITION / NATURE OF WORK

    To

    06/01/09

    CHIEF GIRL SCOUT MEDALIST


    (TREE PLANTING)

    06/01/

    (Continue on separate sheet if necessary)

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


    INCLUSIVE DATES OF ATTENDANCE
    32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write
    in full)

    (mm/dd/yyyy)
    From

    NUMBER OF
    HOURS

    CONDUCTED/ SPONSORED BY
    (Write in full)

    To

    (Continue on separate sheet if necessary)

    VIII. OTHER INFORMATION


    33.

    SPECIAL SKILLS / HOBBIES:

    34.

    NON-ACADEMIC DISTINCTIONS / RECOGNITION:


    (Write in full)

    35.

    MEMBERSHIP IN
    ASSOCIATION/ORGANIZATION
    (Write in full)

    (Continue on separate sheet if necessary)


    GSIS PDS Form Page 3 of 4

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


    a. Within the third degree

    Yes / No : NO
    If YES, give details:
    _____________________________________
    _____________________________________
    _____________________________________

    b. Within the fourth

    Yes / No : NO
    If YES, give details:
    _____________________________________
    _____________________________________
    _____________________________________

    (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?
    degree (for Local Government Employees):
    appointing authority or recommending authority where you will be appointed?

    37 a. Have you ever been formally charged?

    Yes / No

    : NO

    If YES, give details:


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

    Yes / No : 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 / No : NO
    If YES, give details:
    ________________________________
    ________________________________

    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)?

    Yes / No

    : NO

    Yes / No

    : NO

    If YES, give details:


    ________________________________
    ________________________________
    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:
    a.

    Are you a member of any indigenous group?

    b.

    Are you differently abled?

    c.

    Are you a solo parent?

    Yes / No : NO
    If YES, please specify: ____________________
    Yes / No : NO
    If YES, please specify: ____________________
    Yes / No : NO
    If YES, please specify: ____________________

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


    NAME

    ADDRESS

    TEL. NO.
    ID picture taken within
    the last 6 months
    3.5 cm. X 4.5 cm
    (passport size)

    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.

    Computer generated
    or xerox copy of picture
    is not acceptable

    PHOTO

    PRC 902894475
    COMMUNITY TAX CERTIFICATE NO.

    ILOILO CITY
    ISSUED AT

    SIGNATURE (Sign inside the box)

    01/16/2014
    ISSUED ON (mm/dd/yyyy)

    DATE ACCOMPLISHED

    RIGHT THUMBMARK

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

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