Jetcsc Form 212

7/23/2019 Jetcsc Form 212

http://slidepdf.com/reader/full/jetcsc-form-212 1/5

;CSC FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes with / and use separate sheet if necessary CSC ID

No

(to beled up by CSC)

I. PERSONAL INFORMATION

. S!"#$M%

&'"S #$M%

M'*%#$M%

TAYONGTONG

JEFFRY INOCENTES +. #$M% %,%#'-# (e.g.

r. Sr.)

0. $% -& 1'"2(33/dd/yyyy)

Febraury 8,1977

45. "%S'%#'$*$"%SS The Istana Bloc ! "ot

8#, $ala%asan%1E,I&us Ca'(te6. P*$C% -& 1'"2 Iloilo City

7'PC-%

5. S%, / Male &e3ale

8. C'9'* S$!S Single :idowed

Married Separated

$nnulled -thersspecify ;;;;;;;

1)11

48. %*%P2-#% #-. N* 4<. P%"M$#%#$"%SS

7'P

C-%

East +alenc(a,Buena'(sta, u(&aras

FILIPINO

=. 2%'>2 (3) 1-7

4?. :%'>2 (kg) .8

44. 1*-- @P% * 4=. %*%P2-#% #-. N*

4. >S'S ' #-.N*

?. %AM$'* $"%SS(if any)

/e0rytayon%ton%yahoo2co&

4+. P$>A'1'> '#-.

1)8))).7.7!! 4. C%**P2-#% #-. (if

any)

)9179)-.)33

40. P2'*2%$*2 )!#))##)--18 . $>%#C@%MP*-@%% #-.

S)).))

46. SSS #-. 338#3-8-.1 +. '# #3!4.#-49.9

II. FAMILY BACKGROUND

0. SP-!S%SS!"#$M%

*B*YOYO6. #$M% -& C2'* (:rite fullna3e and list all)

$% -& 1'"2(33/dd/yyy)

&'"S #$M%

RESTY Ca&(lle 5ate

Tayon%ton%

No'e&ber !2 #))1

M'*% #$M% 6ER*"T*

-CC!P$'-#

%MP*-@%"/1!S.#$M%

N*

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N*

%*%P2-#% #-. N*

5. &$2%" S!"#$M%

&'"S #$M%

M'*% #$M%

T*YONTON JOE *R"ENE

$ENO*

8. M-2%"S M$'%##$M%

S!"#$M%INOCENTES

&'"S #$M%

JENNIFER

M'*% #$M%

$O"*RTO

III. EDUCATIONAL BACKGROUND

mailto:[email protected]






<. *%9%* #$M% -& SC2--*(:rite in full)

%>"%%C-!"S%

(:rite in full)

@%$">"$!$%

(if

graduated)

2'>2%S>"$%/*%9%*/!#'S

%$"#%(if not

graduated)

'#C*!S'9%$%S -&$%#$#C%

SC2-*$"S2'P/

$C$%M'C2-#-"S"%C%'9%

&ro3 o

%*%M%#$"@ E*ST +*"ENCI*,

BEN*+IST*R*SE"E$ENT*R

Y 199)

R**TE

198!

199)

N*

S%C-#$"@

E*ST +*"ENCI*, N*TION*"

:I:SC:OO"

SECON* RY

199-R**T

E199

)199-

N*

9-C$'-#$*/ "$%C-!"S%

N* N* N* N* N*

C-**%>%

I$*R*S6O"YTEC:NIC

CO""EE

BS *ERON*TIC*

"ENINEERIN

#))1R**T

E199

.#))1

N*

CS &-"M 4 ("eBised ??6) Page 4 of 0

IV. CIVIL SERVICE ELIGIBILITY

=. C$"%%" S%"9'C% "$4?<?(1-$"/1$") !#%" SP%C'$**$:S/C%S/CS%%

"$'#>

$% -&%,$M'#$'-#/C-#&%"M%#

P*$C% -&%,$M'#$'-#/C-#&%"M

%#

*'C%#C% (if applicable)

#!M1%"

$% -&"%*%$S%

"ICENSRE E;*$

FOR TE*C:ER

772)

8

)7<#.<#))

)

I"OI"O CITY NA

CCS 6O"ICEOFFICER 1

8)2#)

)9<1-<#)))

I"OI"O CITY NA

V. WORK EXPERIENCE (Include !"#$%e e&l'&en% S%$!% )!'& 'u! cu!!en% *'!+,+?. '#C*!S'9%

$%S

(33/dd/yyyy)

P-S''-# '*%

(:rite infull)

%P$"M%#/$>%#C@/-&&'C%/

C-MP$#@(:rite in full)

M-#2* @

S$*$"@

S$*$"@

>"$%

S%P

'#C"%M%#(&or3at ??A?)

S$!S -&

$PP-'#M%#

>-9

S%"9'C%(@es/#o)

&ro3 o

08/04/2004

TO*TE

6O"ICEOFFCIER

#6N6 S*F *IR NIT

1#,#1)2))

6ER$*NENT

YES

)7<)1<#))8

1#<3)<#))8

6O"ICEOFFICER

16N6 S*F

9,!..2))

6ER$*NENT

YES

)3<#3<#)).

).<3)<#))8

6O"ICEOFFICER

16N6 S*F

8,.)-2))

6ER$*NENT

YES

1#<1!<#))1

)3<##<#)

).

6O"ICE

OFFICER 1

6N6 S*F

8,.)-2))

6ER$*NENT YES



CS FOR$ #1# =Re'(se> #))-? 6a%e # o@ !

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC-NONGOVERNMENT -PEOPLE - VOLUNTARY ORGANI/ATIONS

#$M% $"%SS -& -">$#'7$'-# (:rite in full))

'#C*!S'9%$%S

(33/dd/yyyy)

#!M1%" -&2-!"S

P-S''-# / #$!"% -&:-"D

&ro3 o

N* N*

VII. TRAINING PROGRAMS (S%$!% )!'& %0e &'1% !ecen% %!$"n"n2,+.'*% -& S%M'#$"/ C-#&%"%#C%/:-"DS2-P/ S2-" C-!"S%S (:ritein full)

'#C*!S'9% $%S -&$%#%#C%

(33/dd/yyyy)

#!M1%" -&

2-!"S

C-#!C%/SP-#S-"%1@

(:rite in full)

&"-M - CRI$E IN+ISTI*TION

*NETECTION

CORSE=CRIEC?

)1<17<#)11

).<1-<#)11

7.)

NFSTI 66SC, Ca&A +(cente"(& Cala&ba, "u%una

6N64S*F CO$$*NO )-<)-<#))3

)!<#.<#))!

1,)!) 6N6 S*FTB



6B"IC S*FETY B*SICRECRIT

CORSE =6SBRC?

6NTI INSTITTETR*ININ RO6

VIII. OT3ERINFORMATION

+0. #-#A$C$%M'C 'S'#C'-#S /"%C->#''-#E (write in full)

+6. M%M1%"S2'P'#

$SS-C'$'-#/-">$#'7$'-# (:rite in full)

++. SP%C'$* SD'**S / 2-11'%SE

AIRCRAFT MECHANIC

DRIVING

CS &-"M 4 ("eBised ??6) Page + of 0

+5. $re you related by consanguinity of aFnity to any ofthe followingE

a. :ithin the third degree (for #ational >oBern3ent %3ployee)E appointing authority reco33ending authority chief ofoFce/bureau/depart3ent or

person who has i33ediate superBision oBer you in the -Fce1ureau or epart3ent

where you will be appointedG

b. :ithin the fourth degree (for *ocal >oBern3ent %3ployee)E appointing authority or reco33ending authority where youwill be appointedG

@%S , #- 'f @%S giBe detailsE ;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;

@%S #-'f @%S giBe detailsE

;;;;;;;;;;;;;;;;;;;;;;;;;

+8. a. 2aBe you eBer been for3ally chargeG

b. 2aBe you eBer been guilty of any ad3inistratiBe oHenseG

@%S #-

'f @%S giBe detailsE ;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;

@%S #-'f @%S giBe detailsE

;;;;;;;;;;;;;;;;;;;;;;;;;



' picture taken within

the last 5 3onths

+.6 c3. x 0.6 c3

(passport siIe)

Co3puter generatedor ,erox copy of picture

is not accepted

+<. 2aBe you eBer been conBicted of any cri3e or Biolation of anylaw decree ordinance or regulation by any court or tribunalG

@%S #- 'f @%S giBe detailsE ;;;;;;;;;;;;;;;;;;;;;;;;;

+=. 2aBe you eBer been separated fro3 the serBice in any of thefollowing 3odesE resignation retire3ent dropped fro3 the rolls dis3issal ter3ination endof ter3 nished contract $:-*

or phased out in the public or priBate sectorG

@%S #- 'f @%S giBe detailsE

;;;;;;;; ;;;;; ;;;;;;;;; 0?. 2aBe you eBer candidate in national or local election (except1arangay election)G

@%S #- 'f @%S giBe detailsE ;;;;;;;;;;;;;;;;;;;;;;;;

04. Pursuant toE (a) 'ndigenous People Js $ct ("$ <+84)K (b) MagnaCarta for isabled Persons ("$ 888)K and (c) Solo Parents:elfare $ct ??? ("$ <=8) please answer the following ite3sE

a. $re you a 3e3ber of any indigenous groupG

b. $re you diHerently abledG

c. $re you a solo parentG

@%S #-

'f @%S please specifyE !:$*' '&!>$-

@%S #-

'f @%S please specifyE ;;;;;;;;;;;; @%S #-

'f @%S please specifyE ;;;;;;;;;;;;

0. "%&%"%#C%S

#$M% $"%SS %*.#-.

JE EIN CE

6N6 :an%ar, en2 *'2 *rea, $an(lao&est(c *(rAort, 6asay C(ty

8-#3-1-

ON*" E"IC*NO6N6 :an%ar, en2 *'2 *rea, $an(lao&est(c *(rAort, 6asay C(ty

8-#3-1-

JOSE R*$SIE + CE6E 6N6 :an%ar, en2 *'2 *rea, $an(lao&est(c *(rAort, 6asay C(ty 8-#3-1-0+. ' declared under oath that this Personal ata Sheet has beenacco3plished by 3e and is true correct and co3plete state3entpursuant to the proBision of pertinent laws rules and regulations of the"epublic of the Philippines.

' also authoriIed the agency head/authoriIed representatiBe to Berify /Balidate the contents stated herein. ' trust that this infor3ation shallre3ain condential.

CS &-"M 4 ("eBised ??6) Page 0 of 0

C-MM!#'@ $, C%"'&'C$% #"

S'>#$!"%'SS!% $

$% $CC-MP*'S2%'SS!% -# (MM//@@@@)RIGHT THUMBMARK

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Jetcsc Form 212