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 FIRST NAME MIDDLE NAME 4. DATE OF BIRTH (mm/dd/yyyy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS

M | A | D |A | L | E | L | R | A | |D

O | G | D | I | |

| O |

| G | |

| |

| |

| |

| |

| |

| |
None

| |

3. NAME EXTENSION (e.g. Jr., Sr.)

06/21/1968
Fem ale Widowed Separated

16. RESIDENTIAL ADDRESS

Igbaras, Iloilo
Male Single Married
ZIP CODE 17. TELEPHONE NO.

Jovellar, Igbaras, Iloilo 5029 None Jovellar, Igbaras, Iloilo

ZIP CODE 19. TELEPHONE NO.

18. Annulled Others, specify ___________ PERMANENT ADDRESS 8. CITIZENSHIP 9. HEIGHT (m) 10. WEIGHT (kg) 11. BLOOD TYPE 12. GSIS ID NO. 13. PAG-IBIG ID NO. 14. PHILHEALTH NO. 15. SSS NO.

Filipino 5"5 65 A B68MMLSE012 NONE 11-000027343-0 NONE

Esposado Domingo Ellezar Overseas Contract Worker Capelec Company Ltd. K.S.A.

5029 None

20. E-MAIL ADDRESS (if any) NONE 21. CELLPHONE NO. (if any)09192249100 22. AGENCY EMPLOYEE NO.000172 23. TIN

143-259-941
25. NAME OF CHILD (Write full name and list DATE OF BIRTH (mm/dd/yyyy) all)

II. FAMILY BACKGROUND

24.SPOUSE'S SURNAME FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUS. NAME BUSINESS ADDRESS TELEPHONE NO. (Continue on separate sheet if necessary) 26. FATHER'S SURNAME FIRST NAME MIDDLE NAME

Esposado, Denna Mae Esposado, Doneza Esposado, Dannica

12/06/1987 08/19/1992 /11/12/97 / / / / / / / / / / / / / / / / / / / / /

Samillano Dionisio Garganta Escrupolo Benita Escultura

NAME OF SCHOOL (Write in full) DEGREE COURSE (Write in full) YEAR GRADUATE D

27. MOTHER'S MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME

(Continue on separate sheet if necessary) HIGHEST GRADE/ LEVEL/ UNITS EARNED (if not graduated)

III. EDUCATIONAL BACKGROUND

28. LEVEL

INCLUSIVE DATES OF ATTENDANCE From To

SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

ELEMENTARY

Jovellar Elementary School Igbaras High School

Elem. Secondary

(if 1981 graduated )

graduated graduated

1975 1981

1981 1985

SECONDARY / VOCATIONAL

1985

COLLEGE TRADE COURSE

Central Phil. University West Visayas State University

BSC BEED M. Ed 1991

graduated

1985 1988 1994

1987 1991 1996

GRADUATE STUDIES

West Visayas State University

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

29. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE RATING DATE OF EXAMINATIO N/ CONFERMENT LICENSE (if applicable) PLACE OF EXAMINATION / CONFERMENT NUMBER DATE OF RELEASE

.Professional Board for Teachers Career Service Professional Exam.

75.51% 80.00%

Oct. 25, 1992 Oct. 20, 1991

Iloilo City Iloilo City

March 10, 1993 Jan.27, 1992

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. INCLUSIVE DATES (mm/dd/yyyy) From To POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY (Write in SALARY full)
SALARY GRADE & STEP INCREMENT (Format "000")

GOV'T SERVICE

STATUS OF APPOINTMENT (Yes / 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

INCLUSIVE DATES 31. NAME & ADDRESS OF ORGANIZATION (Write in full) (mm/dd/yyyy) From To NUMBER OF HOURS POSITION / NATURE OF WORK

/ / / / /

/ / / / /

/ / / / /

/ / / / /

(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 OF ATTENDANCE (mm/dd/yyyy) To NUMBER CONDUCTED/ SPONSORED BY OF HOURS (Write in full)

From

The 3rd Generation Library Management: Realities and Challenges to Deal or Not to Deal 1st Digital Information and Education Seminar 2005 Athena Library Automation Software How to Establish, Manage and Maintain Archives in Different Organizations to Bridge the Gap Between Archives and Users Information Analysis Through Indexing and Abstracting of Macro/Micro Documents Technology Application for Excellence in Library Management Managerial Skills on Librarians Personnel Ethics, Effective Communication and Performance Appraisal System Basic Librarianship Skills and Values Development

10/17/2007 10/19/2007 07/28/2005 07/29/2005 02/09/2004 02/11/2004 01/28/1999 01/30/1999 10/16/1996 10/18/1996 05/29/1996 05/31/1996 12/16/1992 12/16/1996 09/19/1992 09/19/1992 06/10/1992 06/11/1992 / / / / / / / / / / / / / / / / / / / /

24 16 24 24 24 24 8 8 16

Philippine Association of Academic and Research Librarians MegaTexts Phil. Inc. Info-Ed Marketing Corporation Professional Librarians' Review Center Professional Librarians' Review Center Association of Special Libraries of the Philippines Phil. Association of State Universities and Colleges Librarians' Asso. WVSU-UNPO WVSU-ULRC

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)

Typing, Filing, Indexing and Cataloging

N/A

N/A

(Continue on separate sheet if necessary)

36. Are

you related by consanguinity or affinity to any of the following : YES NO If YES, give details: _________________________________ Not Applicable _____________________ YES NO If YES, give details: _________________________________ Not Applicable ________ YES NO If YES, give details: ________________________________ Not Applicable____________________ YES NO If YES, give details: ________________________________ __Not Applicable__________________ YES NO If YES, give details: ________________________________ __Not Applicable___________________ YES NO If YES, give details: ________________________________ __Not Applicable__________________ YES NO If YES, give details: ________________________________ ___Not Applicable__________________

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? the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?

b. Within

37 a.

Have you ever been formally charged?

b. Have you ever been guilty of any administrative offense?

38. Have

you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?

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?

40. Have

you ever been a candidate in a national or local election (except Barangay election)?

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: Are you a member of any indigenous group? Are you differently abled? Are you a solo parent?

a. b. c.

YES NO If YES, please specify: _Not Applicable _______ YES NO If YES, please specify: _Not Applicable________ YES NO If YES, please specify: _Not Applicable________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO. 3200870 local 112 3200870 local 112 3200870 local 112
ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size) Computer generated or xerox copy of picture is not acceptable

Rose, Nora Banhaw, Fatima Miraflor, Nelse Grace

43. I

WVSU ULRC WVSU COE/WVSU ULRC WVSU Graduate School Library

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. 03249758
COMMUNITY TAX CERTIFICATE NO.

PHOTO

Iloilo City
ISSUED AT SIGNATURE (Sign inside the box)

01/15/2008
ISSUED ON (mm/dd/yyyy)

06/13/2008
DATE ACCOMPLISHED RIGHT THUMBMARK CS FORM 212 (Revised 2005), Page 4 of 4