Daisy Agawin

CS FORM 212 (Revised 2005) PERSONAL DATA SHEET 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 AGAWIN FIRST NAME DAISY MIDDLE NAME PACTOLERIN 3. NAME EXTENSION (e.g. Jr., Sr.) 4. DATE OF BIRTH 10 / 30 / 1985 16. RESIDENTIAL ADDRESS #198 Zone 6, Bonbon 5. PLACE OF BIRTH CAGAYAN DE ORO CITY Cagayan de Oro City 6. SEX Male Female Misamis Oriental, Philippines 7. CIVIL STATUS  Single Widowed ZIP CODE 9000  Married Separated 17. TELEPHONE NO. n/a  Annulled Others, specify____ 18. PERMANENT ADDRESS #198 Zone 6, Bonbon 8. CITIZENSHIP Filipino Cagayan de Oro City 9. HEIGHT (m) 1.58 Misamis Oriental, Philippines 10. WEIGHT (kg) 55 ZIP CODE 9000 11. BLOOD TYPE ‘B’ 19. TELEPHONE NO. n/a 12. GSIS ID NO. -. E-MAIL ADDRESS -13. PAG-IBIG ID NO. 21. CELLPHONE NO. -. PHILHEALTH NO-. AGENCY EMPLOYEE NO. -. SSS NO. 23. TIN- II. FAMILY BACKGROUND 24. SPOUSE SURNAME AGAWIN 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) FIRST NAME MC PHILIP LAVHYRNE CANDIE P. AGAWIN 02/02/2007 MIDDLE NAME SABUERO OCCUPATION ELECTRICIAN/DRIVER EMPLOYER/BUS. NAME BUSINESS ADDRESS TELEPHONE NO. - (Continue on separate sheet if necessary) 26. FATHER’S SURNAME PACTOLERIN FIRST NAME HENRY MIDDLE NAME PAASA 27. MOTHER’S MAIDEN NAME SURNAME SAMBAAN FIRST NAME NELLIE MIDDLE NAME BURAY (Continue on separate sheet if necessary) III. EDUCATIONAL BACKGROUND 28. LEVEL NAME OF SCHOOL (Write in Full) DEGREE / COURSE (Write in Full) YEAR GRADUATED (if graduated) Highest Grade / Level / Units Earned (if not graduated) INCLUSIVE DATES OF ATTENDANCE SCHOLARSHIP/ ACADEMIC HONORS RECEIVED From To ELEMENTARY BONBON ELEM. SCHOOL PRIMARY (CERTIFICATE) 1998 CERTIFICATE- None SECONDARY CAGAYAN DE ORO NATIONAL HIGH SCHOOL SECONDARY (CERTIFICATE) 2002 CERTIFICATE- None COLLEGE MINDANAO POLYTECHNIC STATE COLLEGE BACHELOR IN COMPUTER ENGINEERING - MINDANAO UNIVERSITY OF SCIENCE AND TECHNOLOGY BACHELOR OF TECHNICIAN TEACHER EDUCATION 2009 DIPLOMA- None GRADUATE (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 RATING Date of Examination / Conferment PLACE OF EXAMINATION / CONFERMENT LICENSE (if applicable) Number Date of Release LICENSURE EXAMINATION FOR TEACHERS 75.40% APRIL 2010 Cagayan de Oro City- (Continue on separate sheet if necessary) V. WORK EXPERIENCE (Include private employment. Start from most recent work experience.) 30. INCLUSIVE DATES POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full) MONTHLY SALARY SALARY GRADE & STEP INCREMENT (Format "00-0") STATUS OF APPOINTMENT GOV'T SERVICE (Yes / No) From To - PRESENT ST-I MACABALAN NATIONAL HIGH SCHOOL 18,549 Permanent YES- ST-I BESIGAN NATIONAL HIGH SCHOOL 18,549 Permanent YES- Instructional Manager ALTENATIVE LEARNING SYSTEM 7,000 Contractual YES- Sales Clerk ROSE PHARMACY 6,500 Contractual NO (Continue on separate sheet if necessary) CS FORM 212 (Revised 2005), Page 2 of 4 VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 31. NAME & ADDRESS OF ORGANIZATION (Write in full) INCLUSIVE DATES (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK From To Mindanao University of Science and Technology Alumni Association 04/2009 present Member Cagayan de Oro Public School Teachers and Employees Association (COPSTEA) 04/2012 present Member (Continue on separate sheet if necessary) VII. TRAINING PROGRAMS (Start from the most recent training.) 32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/ SHORT COURSES (Write in full) INCLUSIVE DATES (mm/dd/yyyy) NUMBER OF HOURS CONDUCTED/ SPONSORED BY (Write in full) From To Trainer’s Methodology (TM) I 11/09/2015 02/04/- TESDA/ Skills Mastery Institute (SMI) HERENCIA Lecture-Workshop- BPI Foundation Parents-Teachers Association Summit and Workshop for Parent Leaders- USAID/City Gov’t./DepEd/XU/Synergeia Foundation Inc. Technical Training in Shielded Metal Arc Welding NCII- XU Center for Integrated Technologies School Based In-Service Training for Teacher- Macabalan National High School Troop Leadership Course- Girls Scout of the Philippines Troop Leadership Course- Girls Scout of the Philippines Gender and Development: RA 9710, VAW-C and Other Law Advocacy- Department of Education Multi-Cluster Inset- Department of Education Briefing/Training of The Establishment of VermiBeds & Provision of Vermi Worms to Identified Schools in Cagayan de Oro City- Department of Agriculture Mass Training of Grade 7 Teachers for the Implementation of K to 12 Basic Curriculum- Department of Education and Teacher Education Council Setting Off The Year Seminar Conference for Alternative Learning System (ALS) Field Implementers, CY- DepEd Alternative Learning System Training of Peer Educators for Adolescent-Firendly Literacy Enhancement Program-. DepEd Alternative Learning System Division Enrichment Seminar Workshop for Literacy Facilitators and Instructional Managers on the Different Programs and Projects in Alternative Learning System (ALS)- DepEd Alternative Learning System . (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) BAKING DANCING ENCODING/SURFING WELDING (Continue on separate sheet if necessary) 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 or 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?  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  NO If 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  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?  YES  NO If YES, give details: Resignation from private sector 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? b. Are you differently abled? c. Are you a solo parent?  YES  NO If YES, please specify: __________________  YES  NO If YES, please specify: __________________  YES  NO If YES, please specify: __________________ 42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO. PHOTO NICK C. PAÑARES, PhD GUSA, CAGAYAN DE ORO CITY RICHARD I. LICAYAN TABLON, CAGAYAN DE ORO CITY HON. JACKY LYNNE B. MERTO BONBON, CAGAYAN DE ORO 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. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential. - COMMUNITY TAX CERTIFICATE NO. MACABALAN, CAGAYAN DE ORO CITY ISSUED AT SIGNATURE (Sign inside the box) 02/02/2016 FEBRUARY 5, 2016 ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK CS FORM 212 (Revised 2005), Page 4 of 4 ADDITIONAL SPOUSES NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) Spouse’s Surname First Middle Occupation ADDITIONAL EDUCATIONAL BACKGROUND / NON-DEGREE COURSES LEVEL NAME OF SCHOOL (Write in Full) DEGREE / COURSE (Write in Full) YEAR GRADUATED (if graduated) Highest Grade / Level / Units Earned (if not graduated) INCLUSIVE DATES OF ATTENDANCE SCHOLARSHIP/ ACADEMIC HONORS RECEIVED From To ADDITIONAL TRAINING PROGRAMS TITLE OF SEMINAR/CONFERENCE/WORKSHOP/ SHORT COURSES (Write in full) INCLUSIVE DATES (mm/dd/yyyy) NUMBER OF HOURS CONDUCTED/ SPONSORED BY (Write in full) From To . . CS FORM 212 (Revised 2005), Page 5