Академический Документы
Профессиональный Документы
Культура Документы
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME MOKAMAD
NAME EXTENSION (JR., SR
FIRST NAME BAI MOHARA
15. AGENCY EMPLOYEE NO. 222 21. E-MAIL ADDRESS (if any) moharabiruar@yahoo.com/bmamilhasa
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME AMILHASAN 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) NAIM ALMAKTOUM M. AMILHASAN
FIRST NAME MENNALDZ
SURNAME BIRUAR
SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person
Dual Citizenship
by naturalization
GONZALO JAVIER
Street
ROSARY HEIGHTS 7
Barangay
Province
9600
MABINI
Street
BAGUA 3
Barangay
Province
09261657211
moharabiruar@yahoo.com/bmamilhasan@gmail.com
2/4/2016
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
1996
NONE NONE
2000
SIGNATURE DATE
CS FORM 212 (Revised 20
LICENSE (if applicable)
Date of
Validity
GOV'T
SERVICE
(Y/
N)
Yes
Yes
Yes
Yes
NO
NO
NO
Yes
Yes
arate sheet if necessary)
Department
Planning and Strategizing Workshop for ESGPPA Focal 10/21/2015 10/24/2015 24 HOURS TECHNICAL
Developmen
Zonal Assembly on ESGPPA Mindanao Cluster 8/26/2015 8/26/2015 8 HOURS TECHNICAL
Department
LGU Orientation on BUB Implementation 10/9/2014 10/11/2014 16 HOURS TECHNICAL
Developmen
Department
DSWD-ARMM Consultation Workshop with Grants team 8/13/2014 8/15/2014 18 HOURS TECHNICAL
Developmen
Department
Skill Enhancement on Technical Writing and Public Speaking 10/23/2013 10/25/2013 16 HOURS TECHNICAL
Developmen
Department
Gender Sensitivity Training 7/25/2013 7/27/2013 16 HOURS TECHNICAL
Developmen
Skills Enhancement Training for Project Development Officers for Institutional Department
5/28/2013 5/31/2013 24 HOURS TECHNICAL
Partnership Level 2 Developmen
Skills Enhancement Training for Project Development Officers for Institutional Department
10/16/2012 10/19/2012 24 HOURS TECHNICAL
Partnership Developmen
Department
Orientation Briefing on DSWD-CSO Engagement on FDS and FDS Plus 8/28/2012 8/31/2012 26 HOURS TECHNICAL
Developmen
Department
Quick Supply Side Assessment Database Training 24 HOURS TECHNICAL
Developmen
Department
Capability Building Training for CPAD 24 HOURS TECHNICAL
Developmen
Department
Pantawid Pamilya Prrogram Orientation 24 HOURS TECHNICAL
Developmen
Leadership Training for Youth Leaders 7/8/2009 7/9/2009 8 HOURS TECHNICAL CCSPC
Department
Compliance, Verification & Grievance System orientation 3/31/2009 4/4/2009 24 HOURS TECHNICAL
Developmen
NOTRE
filing, encoding, cooking, baking 4 YEARS PERFECT ATTENDANCE AWARD DEPA
COTABATO
facilitating
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
NOTRE DAME OF COTABATO FOR GIRLS
DEPARTMENT ALUMNI ASSOCIATION
COTABATO CITY STATE POLYTHECNIC COLLEGE
ALUMNI ASSOCIATION
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:
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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.
ID/License/Passport No.:
Signature (Sign inside the box)
Date/Place of Issuance:
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.