CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15336160

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 CABBAB
FIRST NAME DANIEL
MIDDLE NAME CARAUI 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS Centro II, ANGADANAN, ISABELA

4. DATE OF BIRTH (mm/dd/yyyy) 11 / 29 / 1997
5. PLACE OF BIRTH Angadanan, Isabela
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 3307
Married Separated
17. TELEPHONE NO. N/A
Annuled Others, specify
_________ 18. PERMANENT ADDRESS Centro II, ANGADANAN, ISABELA

8. CITIZENDSHIP Filipino
9. HEIGHT (m) 175
10. WEIGHT (kg) 70 ZIP CODE 3307
11. BLOOD TYPE O+ 19. TELEPHONE NO. N/A
12. GSIS ID NO. N/A 20. EMAIL ADDRESS (if any) danielcabbab456@gmail.com
13. PAGIBIG ID NO. N/A 21. CELLPHONE NO. (if any) 0916344807
14. PHILHEALTH NO. N/A 22. AGENCY EMPLOYEE NO. 1691960
15. SSS NO. N/A 23. TIN N/A

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 Daniel C. Cabbab 11 / 29 / 1997

MIDDLE NAME Jemardan C. Cabbab 06 / 25 / 1996

OCCUPATION Micah C. Cabbab 08 / 24 / 2004

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME Cabbab

FIRST NAME Danilo

MIDDLE NAME Tumaneng

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Caraui

FIRST NAME Maribel

MIDDLE NAME Bayang

III. EDUCATIONAL BACKGROUND

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

2004-06- 2010-04-
ELEMENTARY Angadanan Central School 2010
07 02

Angadanan National High 2010-06- 2014-03-

SECONDARY 2014
School 07 31

VOCATIONAL/ TRADE
COURSE

Isabela State University- Bachelor of 2014-06- 2018-06-

COLLEGE 2018
Angadanan Campus Secondary Education 02 22

Isabela State University-Main Master of Arts in 2019-01-

GRADUATE STUDIES Present
Campus Education 19

IV. CIVIL SERVICE ELIGIBILITY

CABBAB, DANIEL CARAUI - T15336160 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
78 09 / 30 / 2018 Tugegarao City 1691960 01/07/2019
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")

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

Training Workshop In Office Productivity Tools And Basic Computer Isabela State University-
01 / 08 / 2019 01 / 18 / 2019 80
Hardware Installation Angadanan Campus

VIII. OTHER INFORMATION

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

Computer Literate BAILEKANDRA

CABBAB, DANIEL CARAUI - T15336160 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:
_____________________________________
_____________________________________

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.

DR. GRACE D. LADIA San Antonio, Alicia, Isabela 0917 829 9281

PROFESSOR JEFFERSON F. PASCUAL Baui, Angadanan, Isabela 09758247239

PROFESSOR EUGELYN R. FELIX Centro III, Angadanan, Isabela 09355788341

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

20744992

COMMUNITY TAX CERTIFICATE NO.

Angadanan, Isabela

ISSUED AT SIGNATURE (Sign inside the box)

2018-06-27 01 / 23 / 2019

ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

CABBAB, DANIEL CARAUI - T15336160 CS FORM 212 (Revised 2005), Page 3 of 3