CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes
with "
1. CS ID No.
" and use separate sheet if necessary.
(to be filled up by CSC)
I. PERSONAL INFORMATION
I | L |A | G | A | N |
2. SURNAME
FIRST NAME
R | O | S | E | M | A | R | I | E |
MIDDLE NAME
C | A | L | A | M | P | I | A | N | O |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3. |NAME| EXTENSION
|
| (e.g.| Jr., Sr.)
|
|
|
|
|
N/A
16. RESIDENTIAL ADDRESS
06/07/1963
4. DATE OF BIRTH (mm/dd/yyyy)
SAN PABLO CITY
5. PLACE OF BIRTH
Male
6. SEX
7. CIVIL STATUS
Female
218 P. ALCANTARA ST., SAN PABLO CITY
Single
Widowed
Married
Separated
Annulled
Others, specify ___________ 18. PERMANENT ADDRESS
8. CITIZENSHIP
FILIPINO
9. HEIGHT (m)
1.6 METERS
ZIP CODE
4000
(049) 562-7114
17. TELEPHONE NO.
218 P. ALCANTARA ST., SAN PABLO CITY
10. WEIGHT (kg)
57 KILOGRAMS
11. BLOOD TYPE
19. TELEPHONE NO.
12. GSIS ID NO.
63060700798
20. E-MAIL ADDRESS (if any)
13. PAG-IBIG ID NO.
10-70-0014-6596
21. CELLPHONE NO. (if any)
14. PHILHEALTH NO.
19-000097577-3
22. AGENCY EMPLOYEE NO.
15. SSS NO.
04-1058474-7
23. TIN
ZIP CODE
4000
(049) 562-7114
[email protected]
09198290142
COA ID 188581
131-952-187
II. FAMILY BACKGROUND
N/A
24. SPOUSE'S SURNAME
25. NAME OF CHILD (Write full name and list all)
DATE OF BIRTH (mm/dd/yyyy)
N/A
OCCUPATION
N/A
EMPLOYER/BUS. NAME
N/A
BUSINESS ADDRESS
N/A
TELEPHONE NO.
N/A
ILAGAN
FIRST NAME
LORENZO
MIDDLE NAME
MENDOZA
PURIFICACION
SURNAME
CALAMPIANO
FIRST NAME
PURIFICACION
MIDDLE NAME
RODELAS
FIRST NAME
N/A
MIDDLE NAME
N/A
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME
27. MOTHER'S MAIDEN NAME
(Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
28.
YEAR
GRADUATED
NAME OF SCHOOL
LEVEL
(Write in
HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)
DEGREE COURSE
(Write in full)
full)
ELEMENTARY
SECONDARY
VOCATIONAL /
SAN PABLO CENTRAL ELEMENTARY
SCHOOL
INTERMEDIATE
SAN PABLO CITY SCHOOL OF ARTS &
TRADES
SECONDARY
(if graduated)
INCLUSIVE DATES OF
ATTENDANCE
From
To
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
1976
GRADUATED
1971
1976
NONE
1980
GRADUATED
1976
1980
VALEDICTORIAN
1984
GRADUATED
1980
1984
CUM LAUDE
1998
GRADUATED
1995
1998
N/A
TRADE COURSE
COLLEGE
LAGUNA COLLEGE
BACHELOR OF
SCIENCE IN
COMMERCE ACCOUNTING
GRADUATE STUDIES
SAN PABLO COLLEGES
MASTER IN
BUSINESS
ADMINISTRATION
(MBA)
(Continue on separate sheet if necessary)
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29.
RATING
DATE OF
EXAMINATION /
CONFERMENT
CAREER SERVICE SUB-PROFESSIONAL
79.00%
07/17/1983
CAREER SERVICE PROFESSIONAL
P.D.907
CPA BOARD EXAMINATION
75.00%
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
UNDER SPECIAL LAWS/ CES/ CSEE
10/24/1984
LICENSE (if applicable)
PLACE OF EXAMINATION / CONFERMENT
NUMBER
LUCENA CITY
N/A
HONOR GRADUATE
N/A
MANILA
63689
DATE OF
RELEASE
06/06/85
(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
POSITION TITLE
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full)
(Write in full)
GOV'T
SERVICE
MONTHLY
SALARY
SALARY GRADE
& STEP
INCREMENT
(Format "00-0")
STATUS OF
APPOINTMENT
(Yes / No)
1/1/2016
Present
STATE AUDITOR IV
COMMISSION ON AUDIT
24-1
PERMANENT
YES
09/15/2014
12/31/2015
STATE AUDITOR IV
COMMISSION ON AUDIT
24-1
PERMANENT
YES
06/01/2012
09/14/2014
STATE AUDITOR III
COMMISSION ON AUDIT
46,047.00
22-8
PERMANENT
YES
06/01/2011
05/31/2012
STATE AUDITOR III
COMMISSION ON AUDIT
41,457.00
22-8
PERMANENT
YES
06/24/2010
05/31/2011
STATE AUDITOR III
COMMISSION ON AUDIT
36,867.00
22-8
PERMANENT
YES
07/01/2009
06/23/2010
STATE AUDITOR III
COMMISSION ON AUDIT
32,278.00
22-8
PERMANENT
YES
07/01/2008
06/30/2009
STATE AUDITOR III
COMMISSION ON AUDIT
27,688.00
22-8
PERMANENT
YES
07/01/2007
06/30/2008
STATE AUDITOR III
COMMISSION ON AUDIT
25,171.00
22-8
PERMANENT
YES
11/15/2003
06/30/2007
STATE AUDITOR III
COMMISSION ON AUDIT
22,883.00
22-8
PERMANENT
YES
07/01/2001
11/14/2003
STATE AUDITOR III
COMMISSION ON AUDIT
22,325.00
22-7
PERMANENT
YES
01/01/2000
06/30/2001
STATE AUDITOR III
COMMISSION ON AUDIT
21,262.00
22-7
PERMANENT
YES
06/01/1998
12/31/1999
STATE AUDITOR III
COMMISSION ON AUDIT
19,329.00
22-7
PERMANENT
YES
11/01/1997
05/31/1998
STATE AUDITOR III
COMMISSION ON AUDIT
16,667.00
22-1
PERMANENT
YES
02/01/1997
10/31/1997
STATE AUDITOR III
COMMISSION ON AUDIT
14,316.00
22-1
PERMANENT
YES
01/01/1997
01/31/1997
STATE AUDITOR II
COMMISSION ON AUDIT
13,328.00
19-6
PERMANENT
YES
01/01/1996
12/31/1996
STATE AUDITOR II
COMMISSION ON AUDIT
10,207.00
PERMANENT
YES
01/01/1995
12/31/1995
STATE AUDITOR II
COMMISSION ON AUDIT
8,215.00
PERMANENT
YES
01/01/1994
12/31/1994
STATE AUDITOR II
COMMISSION ON AUDIT
7,150.00
PERMANENT
YES
01/01/1993
12/31/1993
STATE AUDITOR II
COMMISSION ON AUDIT
6,450.00
PERMANENT
YES
01/01/1992
12/31/1992
STATE AUDITOR II
COMMISSION ON AUDIT
6,323.00
PERMANENT
YES
07/01/1989
12/31/1992
STATE AUDITOR II
COMMISSION ON AUDIT
6,199.00
N/A
PERMANENT
YES
01/01/1988
06/30/1989
STATE AUDITING EXAMINER
COMMISSION ON AUDIT
2,672.00
N/A
PERMANENT
YES
10/01/1986
12/31/1987
STATE AUDITING EXAMINER
COMMISSION ON AUDIT
2,429.00
N/A
PERMANENT
YES
06/19/1986
09/30/1986
AUDITING EXAMINER III
COMMISSION ON AUDIT
1,715.00
N/A
PERMANENT
YES
12/13/1985
06/18/1986
AUDITING EXAMINER III
COMMISSION ON AUDIT
1,477.00
N/A
PERMANENT
YES
(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. NAME & ADDRESS OF ORGANIZATION
INCLUSIVE DATES
(Write in full)
(mm/dd/yyyy)
From
NONE
NUMBER OF
HOURS
POSITION / NATURE OF WORK
N/A
N/A
To
(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 (Write
in full)
(mm/dd/yyyy)
NUMBER OF
HOURS
CONDUCTED/ SPONSORED BY
(Write in full)
From
To
IMPLEMENTING THE GOV'T ACCOUNTING MANUAL
1/18/16
1/22/16
40
COA, Region IV-B
PICPA ANNUAL NATIONAL CONVENTION
11/25/15
11/28/15
32
PICPA NATIONAL CHAPTER
INTEGRATED RESULTS AND RISK BASED AUDIT SOFTWARE (IRRBAS)
9/21/15
9/28/15
40
COA, Region IV-B
INTEGRATED RESULTS AND RISK BASED AUDIT (IRRBA)
6/30/15
7/9/15
64
COA, Region IV-B
UNIFIED ACCOUNTING CODE AND STRUCTURES (UACS)
11/11/14
11/14/14
40
COA, Region IV-B
GUIDE IN AUDIT OF PROCUREMENT
10/27/14
10/30/14
32
COA, Region IV-B
PHIL.PUBLIC SECTOR ACCTG STANDARDS & REV, CHART OF ACCTS
10/13.14
10/17/14
40
COA, Region IV-B
SEMINAR ON CASH EXAMINATION (Revised)
8/26/2014
8/28/2014
24
COA, Region IV-B
UPDATES ON RA 9184 7 PHIL. BIDDING DOCUMENTS
11/13/2007
11/15/2007
24
COA, Region IV
RBFAM and VFM
07/17/2006
07/28/2006
80
NPC/TRANSCO
BASIC INFORMATION AND COMMUNICATION Technology
05/22/2006
05/26/2006
40
COA, Region IV
GENDER & DEVELOPMENT
09/29/2005
09/30/2005
16
COA, Region IV
FORUM WITH THE EXAMINERS Board of Accountancy
8/26/2005
PICPA ,SAN PABLO CHAPTER
E-FILING, TAX UPDATES & ANTI-MONEY LAUNDERING LAW
02/19/2005
02/19/2005
PICPA ,SAN PABLO CHAPTER
COMPUTER ASSISTED AUDIT TECHNIQUES
04/19/2005
04/22/2005
40
COA, Region IV
FINANCIAL AUDIT (RISK-BASED AUDIT APPROACH)
08/23/2004
08/27/2004
40
CGS CLUSTER III
NEW GOVERNMENT ACCOUNTING SYSTEM (NGAS) CORPORATE
12/14/2004
12/16/2004
24
COA, Region IV
RISK-BASED AUDIT APPROACH
08/23/2004
08/27/2004
40
COA-Cluster III-Corp.
FRAUD INVESTIGATION AND LEGAL EVIDENCE
06/21/2004
06/25/2004
40
COA, Region IV
HUMAN RELATIONS IN WRITING
06/02/2004
06/03/2004
16
COA, Region IV
R.A.9184 & ITS IMPLEMENTING RULES& REGULATIONS
05/26/2004
05/28/2004
24
COA, Region IV
NEW GOVERNMENT ACCOUNTING SYSTEM (NGAS)
05/21/2003
05/23/2003
24
COA, Region IV
GOVERNMENT ELECTRONIC PROCUREMENT SYSTEM (GPES)
03/20/2002
03/20/2002
DBM-Procurement Service
INFORMATION SYSTEM AUDIT ( ON THE JOB TRAINING)
10/01/2001
11/06/2001
200
COA, Region IV
INFORMATION SYSTEM AUDIT ( MODULE 2)
09/10/2001
09/21/2001
80
COA, Region IV
INFORMATION SYSTEM AUDIT ( MODULE 1)
08/20/2001
08/24/2001
40
COA, Region IV
ANNUAL AUDIT REPORT WRITING
08/06/2001
08/10/2001
40
COA, Region IV
GACPA 23TH ANNUAL NATIONAL CONVENTION
10/03/2000
10/06/2000
32
GACPA
INTERNAL CONTROL SYSTEM EVALUATION
09/18/2000
09/22/2000
40
COA, Region IV
VOW/TEAM BUILDING /ATAP UPDATES
07/10/2000
07/14/2000
40
COA, Region IV
AUDIT SAMPLING
06/14/2000
06/15/2000
16
COA, Region IV
MICROSOFT OFFICE '97
05/15/2000
05/19/2000
40
COA, Region IV
AUDIT TEAM APPROACH ORIENTATION
07/161999
07/18/1998
16
COA, Region IV
UPDATES ON COMPREHENSIVE AUDIT
11/11/1996
11/15/1996
40
COA, Region IV
GACPA 19TH ANNUAL NATIONAL CONVENTION
10/03/1996
10/05/0996
24
GACPA
REFRESHER COURSE
10/02/1995
10/06/1995
40
COA, Region IV
TECHNICAL RESEACH & THESIS WRITING
09/17/1995
09/17/1995
GRADUATED STUDIES, SNPABLOCOLLEGES
NEW CERT. OF SETTLEMENT & BALANCES
07/27/1994
07/29/1994
24
COA, Region IV
AUDIT WORKING PAPER DEVELOPMENT
10/06/1991
10/08/1991
24
COA, Region IV
BARANGAY HIGH SCHOOL ACCOUNTING
07/30/1986
07/31/1986
16
COA, PAO Batangas
04/07/1986
04/11/1986
40
COA, Region IV
ORIENTATION SEMINAR
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
33.
SPECIAL SKILLS / HOBBIES:
NON-ACADEMIC DISTINCTIONS / RECOGNITION:
34.
(Write in full)
35.
MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
SPECIAL SKILL: KNOWLEDGE OF SYSTEMS AUDIT
PHIL.INSTITUTE OF CERTIFIED PUBLIC
ACCOUNTANT
N/A
GOVERNMENT ASSOCIATION OF CERTIFIED
PUBLIC ACCOUNTANT
(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 has
immediate supervision over you in the Office, Bureau or Department where you will be appointed?
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?
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 administrative 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?
40.
Have you ever been a candidate in a national or local election (except Barangay election)?
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?
b.
Are you differently abled?
c.
Are you a solo parent?
YES
NO
If YES, give details:
________________________________
________________________________
YES
/ NO
If YES, give details:
________________________________
________________________________
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.
ELIZABETH T. JOYAS
COA REGION IV-B, Quezon City
09298557339
NATIVIDAD S.GARCIA (Retired COA Supervising Aud)
Muntinlupa City
09291405279
CELIA D. FUENTES
COA REGION IV, Quezon City
09178671285
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
14215200
COMMUNITY TAX CERTIFICATE NO.
SAN PABLO CITY
ISSUED AT
SIGNATURE (Sign inside the box)
03/04/2014
10/10/2014
ISSUED ON (mm/dd/yyyy)
DATE ACCOMPLISHED
RIGHT THUMBMARK
CS FORM 212 (Revised 2005), Page 4 of 4
