CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15283968

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

I. PERSONAL INFORMATION
2. SURNAME POJADAS
FIRST NAME JERLANDO
MIDDLE NAME MODRIGO 3. NAME EXTENSION (e.g. Jr., Sr.) JR.
16. RESIDENTIAL ADDRESS 655 E. Rodriguez Extension, PASAY CITY, NCR
4. DATE OF BIRTH (mm/dd/yyyy) 02 / 15 / 1995
FOURTH DISTRICT
5. PLACE OF BIRTH PASAY CITY
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 1300
Married Separated
17. TELEPHONE NO.
Annuled Others, specify
_________ 18. PERMANENT ADDRESS 551 E. Rodriguez Extension, PASAY CITY, NCR
FOURTH DISTRICT
8. CITIZENDSHIP Filipino
9. HEIGHT (m) 2
10. WEIGHT (kg) 65 ZIP CODE 1300
11. BLOOD TYPE A+ 19. TELEPHONE NO.

12. GSIS ID NO. 20. EMAIL ADDRESS (if any) [email protected]

13. PAGIBIG ID NO. 121027380540 21. CELLPHONE NO. (if any) 09184302844
14. PHILHEALTH NO. 020506881527 22. AGENCY EMPLOYEE NO.

15. SSS NO. 3431704846 23. TIN 422181420

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME POJADAS

FIRST NAME JERLANDO

MIDDLE NAME MODRIGO

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME MODRIGO

FIRST NAME PERLA

MIDDLE NAME POJADAS

III. EDUCATIONAL BACKGROUND

HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE SCHOLARSHIP/
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS
GRADUATED ACADEMIC HONORS
(Write in full) (Write in full) EARNED
(if graduated) RECEIVED
(if not
graduated) From To

Timoteo Paez Elementary 2007-03-

ELEMENTARY 2007 2001-03 Best Pupil (per section)
School 31

2011-03- Student Librarian of the

SECONDARY Pasay City East High School 2011 2007-06
29 Year (PM Shift)

VOCATIONAL/ TRADE
COURSE

BACHELOR OF
2015-03-
COLLEGE City University of Pasay ELEMENTARY 2015 2011-06
30
EDUCATION

GRADUATE STUDIES

IV. CIVIL SERVICE ELIGIBILITY

POJADAS, JERLANDO MODRIGO - T15283968 CS FORM 212 (Revised 2005), Page 1 of 3
29. LICENSE (if applicable)
DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE
LET (LICENSURE EXAMINATION FOR
75.40 09 / 20 / 2015 Polytechnic University of the Philippines 1436051 11/30/2015
TEACHER)

V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")

AMA Computer College -

06/13/2017 04/23/2018 Teacher 13,000 0-0 No
MAKATI branch

Eastern Achiever Academy of

06/08/2015 03/27/2017 Teacher 6,000 0-0 No
Taguig Inc.,

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

31. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF
POSITION / NATURE OF WORK
(Write in full) HOURS
From To

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

32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

Dr. Alvin Pang and Dr. Roderick

International Seminar-Workshop on English Teaching 02 / 02 / 2018 02 / 04 / 2018 12
Aguirre

Innovations in Education: The 21st Century Teacher 05 / 26 / 2015 05 / 26 / 2015 8 Dr. Victoria R. Mayo

VIII. OTHER INFORMATION

33. 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: 35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION
SPECIAL SKILLS / HOBBIES:
(Write in full) (Write in full)

Singing

POJADAS, JERLANDO MODRIGO - T15283968 CS FORM 212 (Revised 2005), Page 2 of 3

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

a. Within the third degree (for National Government Employees): YES NO

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 If YES, give details:
appointed? _____________________________________
_____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where you will be appointed?
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37. a. Have you ever been formally charged? YES NO

If YES, give details:
_____________________________________
_____________________________________

b. Have you ever been guilty of any administrative offense? YES NO

If YES, give details:
_____________________________________
_____________________________________

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
_____________________________________
_____________________________________

39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
Resignation

40. Have you ever been a candidate in a national or local election (except Barangay election)? YES 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? YES NO

If YES, please specify:_______________________
b. Are you differently abled? YES NO
If YES, please specify:_______________________
c. Are you a solo parent? YES NO
If YES, please specify:_______________________

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

NAME ADDRESS TEL. NO.

Loujean M. Pojadas 555 E. Rodriguez Ext. Malibay Pasay 09307115440

City

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.
X
I also authorize the agency head / authorized representative to 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 THUMBMARK

POJADAS, JERLANDO MODRIGO - T15283968 CS FORM 212 (Revised 2005), Page 3 of 3