Академический Документы
Профессиональный Документы
Культура Документы
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME DIONSON
FIRST NAME LLOYD
MIDDLE NAME REYES
3. DATE OF BIRTH
(mm/dd/yyyy) 9/30/1973 16. CITIZENSHIP Filipino Dual Citiz
6 CIVIL STATUS
Single Married 17. RESIDENTIAL ADDRESS 98
Widowed Separated House/Block/Lot No.
Other/s:
Subdivision/Village
7. HEIGHT (m) 1.67 BAIS CITY
City/Municipality
8. WEIGHT (kg) 75 ZIP CODE 6206
9. BLOOD TYPE A+ 18. PERMANENT ADDRESS 98
House/Block/Lot No.
SURNAME REYES
FIRST NAME ERNA
MIDDLE NAME GONZALES (Continue on separate shee
SECONDARY /
VOCATIONAL BAIS CITY HIGH SCHOOL 1986 1990
TRADE
COMPUTER COLLEGE OF THE BACHELOR OF SCIENCE IN
COURSE
COLLEGE 1991 1995
VISAYAS COMPUTER SCIENCE
NEGROS ORIENTAL STATE CERTIFICATE IN
2002 2003
UNIVERSITY (GGMC) PROFESSIONAL EDUCATION
NEGROS ORIENTAL STATE MASTERS OF SCIENCE IN
GRADUATE STUDIES 2004 2007
UNIVERSITY (MAIN CAMPUS) INFORMATION TECHNOLOGY
(Continue on separate sheet if necessary)
SIGNATURE DATE
AL DATA SHEET
rk Experience Sheet shall cause the filing of administrative/criminal case/s against the person
TAVERA STREET
Street
BARANGAY 2
Barangay
NEGROS ORIENTAL
Province
6206
TAVERA STREET
Street
BARANGAY 2
Barangay
NEGROS ORIENTAL
Province
6206
lloyd.dionson@deped.gov.ph
23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
ELEMENTARY VALEDIC-
1986 TORIAN
GRADUATE
H.S. 1ST HON.
1990 MENTION
GRADUATE
ACADEMIC,
GRADUATED 1995 COMPUTER
EXCELLENCE
GRADUATED 2003
COMPLETED
ACADEMIC
REQUIREMENTS
e on separate sheet if necessary)
SIGNATURE DATE
CS FORM 2
LICENSE (if applicable)
NUMBER Date of
Validity
10-15-
02878108
03
STATUS OF
APPOINTMENT
(Y/
N)
Permanent Yes
Permanent Yes
Permanent Yes
Permanent Yes
Fulltime No
Fulltime Yes
Fulltime Yes
Regular No
Regular No
Regular No
Contractual No
Contractual Yes
on separate sheet if necessary)
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
If YES, give details:
________________________________
35. a. Have you ever been found guilty of any administrative offense? YES NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation YES NO
by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. 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 or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except YES NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES NO
election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country? YES NO
If YES, give details (country):
40. 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 a person with disability? YES NO
If YES, please specify ID No:
c. Are you a solo parent? YES NO
If YES, please specify ID No:
JALUAG, DAISY D. Juan Luna St. Bais City With full and han
name tag and sign
printed nam
SANTOS, YVONNE N. Juan Luna St. Bais City Computer gene
42. or photocopied
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and is not accept
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein.
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.
Date/Place of Issuance: 11/21/2003 CEBU CITY - PRC Date Accomplished Right Thumbm
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicate
NO
NO
If YES, give details (country):
NO
NO
NO
Computer generated
or photocopied picture
is not acceptable
PHOTO
Right Thumbmark