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

L A N G I S T O P H E R O S
11/19/1982 BINMALEY, PANGASINAN 16. RESIDENTIAL ADDRESS 3. Name EXTENSION (e.g. Jr. Sr.)

C H R A B A L

4. DATE OF BIRTH (mm/dd/yyyy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS Male Single Married Annulled 8. CITEZENSHIP 9. HEIGHT (m) 10. WEIGHT (kg) 11. BLOOD TYPE 12. GSIS ID NO. 13. PAG-IBIG ID NO. 14. PHILHEALTH NO. 15. SSS NO.

553 CANAOALAN, BINMALEY, PANGASINAN

ZIP CODE 17. TELEPHONE NO. 18. PERMANENT ADDRESS

Female Widowed Separated Others, specify FILIPINO 1.7 m 78 kg "A" ZIP CODE 19. TELEPHONE NO. 20. E-MAIL ADDRESS (if any) 21. CELLPHONE NO. (if any) 05 - 000086375 - 8 02 - 3272480 - 8 22. AGENCY EMPLOYEE NO. 23. TIN
christopher_silang@yahoo.com

2417

553 CANAOALAN, BINMALEY, PANGASINAN 2417

9098019583 402 - 011 - 628

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUS NAME BUSINESS ADDRESS TELEPHONE NO. (Continue on a separate sheet if necessary) FATHER'S SURNAME FIRST NAME MIDDLE NAME 27. MOTHER'S MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME

SILANG SHERYL PADILLA TEACHING SABANGAN E/S BINMALEY, PANGASINAN

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

DATE OF BIRTH (mm/dd/yyyy)

PETER RENZO P. SILANG JAMES ZOREN P. SILANG

7/11/2006 1/17/2012 / / / / / / / / / / / / / / / / / / / /

SILANG REYNALDO ABALOS

ABALOS JUANITA MISLANG

(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 RECEVED

ELEMENTARY SECONDARY VOCATIONAL/ A TRADE COURSE COLLEGE

CANAOALAN E/S BINMALEY CATHOLIC H.S.

1995 1999

1989 1995

1995 1999

UNIVESITY OF LUZON UNIVESITY OF LUZON

GRADUATE STUDIES

B.S.E.E. B.S.S.Ed. MAEd

2003 21 units
FINISHED ACAD. REQ.

1999 2008 2009

2003 2009 2012

UNIVESITY OF LUZON

(Continue on a separate sheet if necessary) Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

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

REGISTERED PROFESSIONAL TEACHER

81.8 70 76

OCT. 4, 2009
SEPT. 20,2003
SEPT. 24, 2002

BAGUIO CITY MANILA BAGUIO CITY

1042705 33369 27595

1/4/2010
11/19/2003

REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN

11/17/2002

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30. A INCLUSIVE DATES (mm/dd/yyyy) From To POSITION TITLE (Write in full) DEPARTMENT / AGENCY / OFFICE/ COMPANY (Write in full) MONTHLY SALARY
SALARY GRADE & STEP INCREMENT (Formal "00.0")

STATUS OF APPOINTMENT

GOV'T SERVICE (Yes / No)

9/21/2010 PRESENT 2008 2010

TEACHER I INSTRUCTOR
ELECTRICAL ENGINEER / TECHNICIAN

DEPED/ BINMALEY SCHOOL OF FISHERIES

SG-11 6 000 6 000

PERMANENT PART - TIME CONTRACTUAL

YES NO YES

UNIVERSITY OF LUZON
BUREAU OF FISHERIES AND AQUATIC RESOURCES

NOV. 2003 NOV. 2008 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /

(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

31. a NAME & ADDRESS OF ORGANIZATION (Write in full) INCLUSIVE DATES (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 A (Write in full) INCLUSIVE DATES ATTENDANCE (mm/dd/yyyy) From To NUMBER OF HOURS CONDUCTED / SPONSORED BY (Write in full)

INSET in Mathematics LEVEL 3 TRAINING ON THE ENHANCED BASIC EDUCATION INFORMATION SYSTEM (EBEIS) REGIONAL MASS TRAINING OF 2ND YEAR TEACHER TEACHING SCIENCE AND MATHEMATICS MANAGING TEACHING AND LEARNING THROUGH ICT OR TECHNICAL - VOCATIONAL TEACHERS

10/27/2012 8/22/2011 5/10/2011 4/29/2011 / / / / / / / / / / / / / / / / / / / / / /

10/29/2012 8/22/2011 5/13/2011 5/1/2011 / / / / / / / / / / / / / / / / / / / / / /

24 4 24 24

DIVISION OF PANGASINAN I, LINGAYEN, PANGASINAN DIVISION OF PANGASINAN I, LINGAYEN, PANGASINAN DEPED REGION I DEPED CENTRAL OFFICE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

(Continue on separate sheet if necessary) Page 3 of 4

36. Are you related by consanguinity or affinity to any of the following: YES 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? Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed? NO

If YES, give details:

b.

YES NO 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 adiministrative offense?

YES NO If YES, give details:

38. 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:

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?

YES NO 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. b. c. Are you a member of any indigenous group? Are you differently abled? 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 FERDINAND S. BRAVO WESTLY R. ROSARIO VIRGINIA M. NESPEOS ADDRESS BINMALEY SCHOOL OF FISHERIES, BIN. PANG. BFAR - DAGUPAN CITY UNIVERSITY OF LUZON 075 - 523 - 5412 9394115654
Computer generated or xerox copy of picture is not acceptable

TEL. NO.
ID picture taken within the last 6 months. 3.5 cm. X 4.5 cm. (passport size)

43. I declare under oath tha this Personal Data Sheet has been accomplished by me, and is a true, correct and complete statement pursuant to the provision of pertinent laws, rules and regulations of the Republic of the Philippines. I also authorized the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential.

PHOTO

COMMUNITY TAX CERTIFICATE NO. ISSUED AT / / ISSUED ON (mm/dd/yyyy) SIGNATURE (Sign inside the box) DATE ACCOMPLISHED

RIGHT THUMBMARK
CS FORM 212 (Revised 2005) Page 4 of 4