Академический Документы
Профессиональный Документы
Культура Документы
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME GARCIA
NAME EXTENSION (JR., SR)
FIRST NAME MA. GELENE
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) ma_gelene_garcia@dlsl.edu.ph / adamgelian28@gmail.com
OCCUPATION N/A
SURNAME ULITIN
GRADUATE STUDIES
tizenship
birth by naturalization
s. indicate country:
PUROK 1
Street
GULOD
Barangay
BATANGAS
Province
PUROK 1
Street
GULOD
Barangay
BATANGAS
Province
gelian28@gmail.com
8/28/2013
8/8/2015
if necessary)
SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED
SALUTATO
2009
RIAN
WITH
2013 HONORS
N/A N/A
January 3, 2020
LICENSURE EXAMINATION FOR TEACHERS 80.0 9/29/2019 LUCENA CITY 1827882 10/28/2023
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To
N/A N/A
TEACH FOR THE PHILIPPINES' ORIENTATION- TEACH FOR THE PHILIPPINES (MS. JOYCE
3/28/2019 3/28/2019 8 HRS SUPERVISORY
SEMINAR ANGELI DONAIRE)
PREPARING TEACHERS TOWARDS RESPONSIBLE
3/7/2019 3/7/2019 8 HRS SUPERVISORY MS. PATRICE MANGULABNAN
GLOBAL CITIZENSHIP EDUCATION
21ST CENTURY ASSESSMENT PRACTICES 1/24/2019 1/24/2019 8 HRS SUPERVISORY DR. JAY MCTIGHE
DISASTER PREPAREDNESS SEMINAR 4/6/2018 4/6/2018 4 HRS TECHNICAL DLSL EDUCATOR'S CIRCLE
CHILD PROTECTION LAW 5/8/2017 5/8/2017 4 HRS TECHNICAL DLSL EDUCATORS' CIRCLE
EDUCATORS' CONGRESS 2017 3/11/2017 3/11/2017 8 HRS SUPERVISORY DLSL EDUCATORS' CIRCLE
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 3 of 4
34. Are you related by consanguinity or affinity to the appointing or recommending authority, or
to theof bureau or office or to the person who has immediate supervision over you in the
chief
Office,
Bureau or Department where you will be apppointed,
a. within the third degree? YES ✘ NO
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 by any court or tribunal?
YES ✘ NO
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 If YES, give details:
phased out (abolition) in the public or private sector? ________________________________
RESIGNATION DUE TO UNAVOIDABLE REASONS
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year
YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last 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
a.
items:
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:
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.