CSC FORM 212(REVISED 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes with and use separate sheet if necessary
I. PERSONAL INFORMATION 2. SURNAME FIRST NAME MIDDLE NAME

1 CS ID NO (To be filled-up by CSC)

IA IVIE INI DIA I I OI

I I

I I

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

IM IA IRII I A I I PI I I L I I I P I I I N I AI I R IO I Y I E I N I A I I I I I I

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

06/ 12/ 1981

16. RESIDENTIAL ADDRESS

#15646 Brgy. Malinta, Los Banos, Laguna

Los Banos, Laguna

Male Single / Married Annulled / Female Widowed Separated Others, Specify ______ 17. TELEPHONE NO. 18. PERMANENT ADDRESS ZIP CODE

4030 N/A #15646 Brgy. Malinta, Los Banos, Laguna

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 1.62 57 O
N/A 19. TELEPHONE NO. 20. E-MAIL ADDRESS (if any) 21. CELLPHONE NO. (if any) 22. AGENCY EMPLOYMENT NO. 23. TIN ZIP CODE

4030

sean.philippe_12@yahoo.com

N/A N/A N/A

(049) - 810-1226 271-857-000-000

II. FAMILY BACKGROUND 24. SPOUSES SURNAME FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUS NAME BUSINESS ADDRESS TELEPHONE NO. (Continue on separate sheet if necessary) 26. FATHERS SURNAME FIRST NAME MIDDLE NAME 27. MOTHERS MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME

AVENDAO GILBERT FLORES ARMY PHIL. ARMY CAMP EMILIO AGUINALDO, QUEZON CITY

25. NAME OF CHILD (Write full name and list all)

DATE OF BIRTH (mm/dd/yyyy)

SHANE GILBERT ROYENA AVENDAO

11/28/2005

ROYENA JAIME SALUD

TORDECILLA LEONORA PEREZ

(Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND 28. LEVEL NAME OF SCHOOL (Write in full) DEGREE COURSE (Write in full) YEAR GRADUATED (if graduated) HIGHEST GRADE/ LEVEL/ UNITS EARNED (if not graduated) INCLUSIVE DATES OF ATTENDANCE From To SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

ELEMENTARY SECONDARY
VOCATIONAL/ TRADE COURSE COLLEGE GRADUATE STUDIES

LOS BANOS CENTRAL SCHOOL LICEO DE LOS BANOS N/A LAGUNA COLLEGE OF BUSINESS AND ARTS N/A

Primary Secondary N/A AB PSYCHOLOGY N/A

1994 1998

Graduate Graduate Graduate

1988 1994

1994 1998

N/A N/A N/A

2002

1998

2002

N/A

(Continue on separate sheet if necessary)

PO1 MARIA PILIPINA ROYENA AVENDANO

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY DATE OF EXAMINATION/ CONFERMENT LICENSE (if applicable) PLACE OF EXAMINATION / CONFERMENT NUMBER DATE OF RELEASE

29. CAREER SERVICE /RA 1080 (BOARD/BAR) UNDER SPECIAL LAWS / CES / CSEE

RATING

NAPOLCOM PNP ENTRANCE EXAM

77.83 %

OCT. 28, 2007

CAMP VICENTE LIM, CANLUBANG, CALAMBA CITY, LAGUNA

N/A

JAN. 24, 2008

(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 SALARY GRADE & STEP INCREMENT (Format 0.00

POSITION TITLE (Write in full)

DEPARTMENT/AGENCY/OFFICE/COMPANY (Write in full)

MONTHLY SALARY

STATUS OF APPOINTMENT

GOVT SERVICE (Yes/No)

07/20/09 06/ 01/ 08 08/ 17/ 04

To date 6/18/09 07/15/05

Police Officer 1 Police Officer 1 Philippine Army

Philippine National Police / PRO CALABARZON, LAGUNA, PPO Philippine National Police / PRO CALABARZON, LAGUNA, PPO 9TH INFANTRY DIVISION, PHILIPPINE ARMY, PILI, CAMARINES SUR

9,466.00 8,605.00 8,605.00

Grade 10-0 Grade 10-0 Grade 10-0

Permanent Temporary Permanent

Yes Yes Yes

(Continue on separate sheet if necessary)

PO1 MARIA PILIPINA ROYENA AVENDANO CS FORM 212 (Revised 2005) Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATIONS 31. NAME & ADDRESS OF ORGANIZATION (Write in full) INCLUSIVE DATES (mm/dd/yyyy) From To NUMBER OF HOURS

POSITION / NATURE OF WORK

NONE

(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) From To NUMBER OF HOURS CONDUCTED / SPONSORED BY (Write in full)

Public Safety Field Training Program

01/25/09

06/18/09

Institute Training Group, Camp V. Lim, Canlubang, Laguna

Public Safety Basic Recruit Course

06/01/08

01/24/09

1464

Institute Training Group, Camp V. Lim, Canlubang, Laguna

Intelligence Platoon Operation Course 01-2005

04/01/05

05/18/05

360

9th Military Intelligence Battalion, 9th Infantry Division, Philippine Army , Pili, Camarines Sur

Candidate Soldier Course Class 105 2004 Counter Trained with Jungle Warfare Mountain Operation Course

0817/04

03/04/05

1680

9th Division Training Unit, 9th Infantry Division, Philippine Army, Pili, Camarines Sur

(Continue on separate sheet if necessary) VIII. OTHER INFORMATION 33. SPECIAL SKILLS / HOBBIES 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 35. MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)

COMPUTER LITERATE

NA

(Continue on separate sheet if necessary)

PO1 MARIA PILIPINA ROYENA AVENDANO CS FORM 212 (Revised 2005) Page 3 of 4

36. Are you related by consanguinity or affinity to any of the following: 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? YES NO If YES, give details. ____________________________________________ ____________________________________________ ____________________________________________ YES NO If YES, give details. ____________________________________________ ____________________________________________ ____________________________________________ YES NO If YES, give details. ____________________________________________ ____________________________________________ YES NO If YES, give details. ____________________________________________ ____________________________________________ YES NO If YES, give details. ____________________________________________ ____________________________________________ / YES NO If YES, give details. __ Dependency Discharged- Honorably Discharge YES NO If YES, give details. ____________________________________________ ____________________________________________

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

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? Resignation from Military Service Phil. Army

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

41. Pursuant to: (a) Indigenous Peoples Act (RA 8371); (b) Magna Carta for Disabled Persons (RA) 7277); and Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: a. Are you a member of any indigenous group? b. Are you differently abled? c. Are you a solo parent? YES NO If YES, please specify:_____________________________________ YES NO If YES, please specify:_____________________________________ YES NO If YES, please specify:_____________________________________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO.

ID picture taken within the last six months 3.5 cm X 4.5 cm (passport size)

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. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential.

Computer generated or xerox copy

PHOTO

COMMUNITY TAX CERTIFICATE NO. STA. CRUZ, LAGUNA ISSUED AT 03/05/2010 ISSUED ON (mm/dd/yyyy) JANUARY 31, 2010 DATE ACCOMPLISHED RIGHT THUMBMARK

SIGNATURE (Sign inside the box)

CS FORM 212 (Revised 2005) Page 4 of 4