Documente Academic
Documente Profesional
Documente Cultură
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME Bautista
15. AGENCY EMPLOYEE NO. 20010200749 21. E-MAIL ADDRESS (if any) nup.maguindanaoppo@g
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME none 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) Karl Andrea B Barnedo
FIRST NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
MIDDLE NAME
SURNAME Bautista
COLLEGE TRADE Mindanao State University, Marawi City BSBA- Management 1991 1995
COURSE
GRADUATE STUDIES Cotabato City State Polytechnic College MPA 2002 2007
(Continue on separate sheet if necessary)
SIGNATURE DATE
AL DATA SHEET
ork Experience Sheet shall cause the filing of administrative/criminal case/s against the person
Street
Poblacion
Barangay
Maguindanao
Province
9608
Street
Poblacion
Barangay
Maguindanao
Province
9608
none
09175459954
nup.maguindanaoppo@gmail.com
23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
12/26/1956
06/16/1999 2/19/2000 Computer Encoder Department of Agrarian Reform XII 4,000.00 n/a Casual
07/06/1998 11/7/1998 Log Pond Analyst Eversun Development Ltd 4,134.00 n/a Regular
07/01/1997 7/5/1998 Log Pond Analyst Eversun Development Ltd 3,900.00 n/a Regular
01/06/1997 30/06/1997 Log Pond Analyst Eversun Development Ltd 3,406.00 n/a Probationary
(Continue on separate sheet if necessary)
SIGNATURE DATE 10 April 2017
CS FORM 212 (Revised 20
LICENSE (if applicable)
Date of
Validity
n/a
GOV'T
SERVICE
(Y/
N)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
arate sheet if necessary)
10 April 2017
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NA
From To
none
3-day Training on PAIS & RR Writer Software 6/9/2010 6/11/2011 24 Technical PRO IX/ C, RMD
3-day Training on PAIS & RR Writer Software 12/2/2009 12/4/2005 24 Technical PRO XII/ C, RM
Integrated Training Program (Phase II) 9/8/2008 9/17/2008 54 Technical PRO ARMM
Management Technology & Company Orientation 7/28/1996 8/4/1996 100 Technical Eversun Develo
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
PRO ARMM
PRO ARMM
none
10 April 2017
CS FORM 212 (Revised 2017), Page 3 of 4
34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the
chief of bureau or office or to the person who has immediate supervision over you in the Office,
Bureau or Department where you will be apppointed,
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
36. 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:
________________________________
________________________________
37. 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 or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):
40. 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 a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:
SUBSCRIBED AND SWORN to before me this 28th of April 2017 , affiant exhibiting his/her validly issued government ID as indicated above.