Region : Region I

Division :
School ID:
Name of Office / School :

To be Encoded
Manually

Summary from
I.Personal

Total no. of Authorized Positions (per

PSI-POP):
Total no. of Filled-up Plantilla Positions:
Total no. of Personnel Re-assigned to:
Total no. of Personnel reassigned from:
Total no. of contractual employees:
Total no. of casual employees:
Total no. of locally funded employees:

0
0
0

NAME OF PERSONNEL
UNIQUE ITEM
NUMBER

POSITION TITLE PER

PLANTILLA

PARENTHETICAL TITLE

SALARY
GRADE

SALARY
STEP

LAST NAME

FIRST NAME

NAME OF PERSONNEL

MIDDLE NAME

NAME EXTENSION

DATE OF ORIGINAL
DATE OF LAST
DATE OF BIRTH (MMAPPOINTMENT (AS
PROMOTION /
SEX
TIN
DD-YYYY)
NATIONAL) (MM-DD- APPOINTMENT (MMYYYY)
DD-YYYY)

EMPLOYMENT
STATUS

FUNDING

PLACE OF BIRTH
(TOWN, PROVINCE
OR CITY)

CIVIL STATUS

Height
(m)

Weight
(kg)

Blood
Type

GSIS BP
No.

PAG-IBIG
PHILHEALTH No.
No. (Inc but
(Inc but not
not
required)
required)

SSS No.

Residential Address (Inc but not required)

Address (House No, Street Name,
Village/Subd)

Region

Province / District / City

City/ Municipality

Barangay

Telephone No.

Permanent Address (Required)

Address (House No, Street Name,
Village/Subd)

Region

Province / District / City

City / Municipality

Barangay

Telephone No.

Reassigned From
Email Address
(preferably
@deped.gov.ph)

Cellphone No. (if any)

Reassigned From:
Reassigned From: School
Region/ Division/ District
ID

Languages/Dialect
Spoken

NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME
EXTENSION)

RELATIONSHIP

LAST
NAME

FIRST
NAME

FOR CHILD ONLY

MIDDLE
NAME DATE OF BIRTH (MM- OCCUPATION
DD-YYYY)

FOR SPOUSE ONLY

EMPLOYER/B BUSINESS
US. NAME
ADDRESS

NLY
TELEPHONE
NO.

EDUCATIO
NAME
(LAST NAME, FIRST NAME MIDDLE NAME
NAME EXTENSION)

LEVEL

EDUCATIONAL BACKGROUND
INCLUSIVE YEAR
Name of School

From

To

Year
Graduated

Highest Grade/Level/Units
Earned (if not graduated)

Course

Major

Minor

Honors
Received

NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME
EXTENSION)

ELIGIBILITY

RATING

DATE OF EXAM/
CONFERMENT (MMDD-YYYY)

PLACE OF EXAM /
CONFERMENT

LICENSE
NUMBER

ISSUE DATE (MM-DDYYYY)

WORK EXPE
NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME
EXTENSION)

INCLUSIVE DATE (MM-DD-YYYY)

FROM

TO

WORK EXPERIENCES
POSITION
TITLE

DEPARTMENT /
AGENCY / OFFICE

MONTHLY
SALARY

SALARY
RANGE/GRADE

STEP
INCREMENT

STATUS OF
APPOINTMENT

Enter trainings within the last five years starting with the most recent
NAME
(LAST NAME, FIRST NAME MIDDLE NAME NAME
EXTENSION)

ars starting with the most recent

TITLE OF SEMINAR

AREA OF TRAINING

INCLUSIVE DATES (MM-DD-YYYY)

FROM

TO

NO. OF
HOURS

CONDUCTED
BY

PLACE OF
TRAINING