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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET


Print legibly. Mark appropriate boxes q with "P " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME MANALOTO

FIRST NAME HELEN

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

4. DATE OF BIRTH (mm/dd/yyyy) 10/08/1982


16. RESIDENTIAL ADDRESS 239 PUROK 2 MANGGA CACUTUD ARAYAT PAMPANGA

5. PLACE OF BIRTH OAS ALBAY


6. SEX
7. CIVIL STATUS ZIP CODE 2012
17. TELEPHONE NO. NA
18. PERMANENT ADDRESS 239 PUROK 2 MANGGA CACUTUD ARAYAT PAMPANGA

8. CITIZENSHIP FILIPINO
9. HEIGHT (m) 140 m
10. WEIGHT (kg) 50KG ZIP CODE 2012
11. BLOOD TYPE O 19. TELEPHONE NO. NA
12. GSIS ID NO. NA 20. E-MAIL ADDRESS (if any) helenmanaloto1130@gmail.com
13. PAG-IBIG ID NO. 1210-9843-6606 21. CELLPHONE NO. (if any) 09329896088/09151721518
14. PHILHEALTH NO. 07-025394347-3 4162655
22. AGENCY EMPLOYEE NO.
15. SSS NO. 34-0089079-4 23. TIN 434-230-981-000
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME MANALOTO 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAMETEODORO JR FRANCESCA L. MANALOTO 05/11/2007


MIDDLE NA MAGASPAC TRISHA ANDREA L. MANALOTO 11/30/2010
OCCUPATION NONE
EMPLOYER/BUS. NAME NA
BUSINESS ADDRESS NA
TELEPHONE NO. NA
(Continue on separate sheet if necessary)

26. FATHER'S SURNAME LANZUELA


FIRST NAME FELIX
MIDDLE NAME POTANIS
27. MOTHER'S MAIDEN NAME

SURNAME RIMBAO
FIRST NAME GABINA
MIDDLE NAME DASICO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND YEAR


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

(if graduated)
ELEMENTARY BANAO, ELEMENTARY SCHOOL 1996 1990 1996

SECONDARY THE SISTERS OF MARY SCHOOL 2000 1996 2000


VOCATIONAL /

COLLEGE
TRADE COURSE BACHELOR OF SECONDARY
RIZAL TECHNOLOGICAL UNIVERSITY EDUCATION MAJOR IN 2006 2002 2006
FILIPINO

GRADUATE STUDIES
MASTER IN EDUCATION ON
BULACAN STATE UNIVERSITY MAJOR IN FILIPINO
GOING

(Continue on separate sheet if necessary)


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

LICENSURE EXAM FOR TEACHER(LET) 76.00% 03/10/2013 MANUEL L. QUEZON UNIVERSTIY/MANILA 1191160 JUNE 5, 2013

(Continue on separate sheet if necessary)


V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE
30. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY GRADE
(mm/dd/yyyy) MONTHLY & STEP STATUS OF
SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To
(Yes / No)
INTEGRATED CHEMISTS OF THE
09/01/2012 05/14/2013 OFFICE SECRETARY 9,500 TEMPORARY NO
PHILIPPINES

05/15/2013 PRESENT TEACHER 1 JUSTINO SEVILLA HIGH SCHOOL 18,549 11 PERMANENT YES

(Continue on separate sheet if necessary)


TARCILA P. JAVIER 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 NUMBER OF
(Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From To

05/11/2014 present Auditor/ Pananalapi


IGLESIA NI CRISTO 3hrs/week

(Continue on separate sheet if necessary)

VII. TRAINING PROGRAMS (Start from the most recent training.)


INCLUSIVE DATES OF ATTENDANCE
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To

03/11/2004 03/11/2004 8hrs Rizal Technological University


Preparing the future Educators to be effective Teachers
07/30/2004 07/30/2004 7hrs. Rizal Technological University
Personality Development and Leadership seminar
02/23/2005 02/23/2005 Rizal Technological University
Malawakang Pagsasanay pang Teatro 8hrs

12/03/2005 12/03/2005 Rizal Technological University


Boosting your esteem-Empowering your Personality 8hrs

07/21/2014 07/21/2014 JUSTINO SEVILLA HIGH SHOOL


School level Training on Child Protection Policy 8hrs

School Inset of Social Studies and Values Education powerpoint 09/01/2014 09/01/2014 JUSTINO SEVILLA HIGH SHOOL
presentation and movie maker 8hrs

10/21/2014 10/21/2014 Municipality of Arayat Pampanga


Gender and Development ; Responsible Parenthood (GAD) 8hrs

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION: ASSOCIATION/ORGANIZATION
33. SPECIAL SKILLS / HOBBIES: 34. 35.
(Write in full)
(Write in full)
Samahan ng mga nagpapakadaluhasa sa
Computer Literate Larangan ng Filipino
NA

Singing NA

NA

NA

NA
(Continue on separate sheet if necessary)
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 If YES, give details:
has immediate supervision over you in the Office, Bureau or Department where you will be _____________________________________
appointed? _____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees):


appointing authority or recommending authority where you will be appointed? If YES, give details:
_____________________________________
_____________________________________
_____________________________________
37 a. Have you ever been formally charged?

If YES, give details:


_______________________________
_
_______________________________
b. Have you ever been guilty of any administrative offense? _
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? 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? If YES, give details:
_______________________________
_
_______________________________
_
40. Have you ever been a candidate in a national or local election (except Barangay election)?

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?


If YES, please specify: ____________________
b. Are you differently abled?
If YES, please specify: ____________________
c. Are you a solo parent?
If YES, please specify: ____________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

DR. FABIAN M. DAYRIT ATENEO DE MANILA UNIVERSITY 09266310347


DR. LILIBETH DLC. COO UNIVERSITY OF THE PHILIPPINES 09178003266

DR. GLENN V. ALEA DE LA SALLE UNIVERSITY 09228967825


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. PHOTO

29079462
COMMUNITY TAX CERTIFICATE NO.

CITY OF SAN FERNANDO PAMPANGA


ISSUED AT SIGNATURE (Sign inside the box)

11/12/2014 07/31/2015
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4