CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

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

I. PERSONAL INFORMATION
2. SURNAME PACCARANGAN

FIRST NAME ERNESTO JR.

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

4. DATE OF BIRTH (mm/dd/yyyy) 02/19/1950 16. RESIDENTIAL ADDRESS

5. PLACE OF BIRTH CENTRO STO. TOMAS, ISABELA 173 JUAN MIGUEL STREET , VIRA ROXAS, ISABELA
6. SEX Male Female
7. CIVIL STATUS ZIP CODE 3320
Single Widowed
Married Separated 17. TELEPHONE NO.

Annulled Others, specify ___________ 18. PERMANENT ADDRESS

8. CITIZENSHIP FILIPINO 173 JUAN MIGUEL STREET , VIRA ROXAS, ISABELA

9. HEIGHT (m) 1.7 M
10. WEIGHT (kg) 65 KG ZIP CODE 3320
11. BLOOD TYPE TYPE O 19. TELEPHONE NO.

12. GSIS ID NO. BJOCKEG9017 20. E-MAIL ADDRESS (if any)

13. PAG-IBIG ID NO. 21. CELLPHONE NO. (if any) 09084468976

14. PHILHEALTH NO. 06-000035602-9 22. AGENCY EMPLOYEE NO.

15. SSS NO. 23. TIN 199-866-492

II. FAMILY BACKGROUND
24.
SPOUSE'S SURNAME PACCARANGAN 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME CELIA ERNICEL P. PACCARANGAN 09/19/1977

MIDDLE NAME BAGUNU REDENTOR P. PACCARANGAN 01/29/1980
OCCUPATION AGRICULTURIST SNOOKY P. PACCARANGAN 11/26/1982
EMPLOYER/BUS. NAME LOCAL GOVERNMENT UNIT PEDRO P. PACCARANGAN 03/29/1985
BUSINESS ADDRESS ROXAS, ISABELA / /
TELEPHONE NO. / /
(Continue on separate sheet if necessary) / /
26.FATHER'S SURNAME PACCARANGAN / /
FIRST NAME ERNESTO SR. / /
MIDDLE NAME MANALO / /
27.
MOTHER'S MAIDEN NAME / /
SURNAME GUMIRAN / /
FIRST NAME CONSTANTINO / /
MIDDLE NAME CALLUENG (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 STO. TOMAS CENTRAL SCHOOL GRADE VI 1963 1957 1963

CAGAYAN VALLEY INSTITUTE OF

SECONDARY
VOCATIONAL / HIGH SCHOOL 1967 1963 1967
TECHONOLOGY
GREGORIO PERFECTO AQUINO
SECRETARIAL 1969 1968 1969
VOCATIONAL SCHOOL
COLLEGETRADE CAGAYAN VALLEY INSTITUTE OF
COURSE
TECHONOLOGY BACHELOR OF
SCIENCE IN
INSTITUTE OF TECHNOLOGY AGRICULTURE 1976 1972 1976

GRADUATE STUDIES
ISABELA COLLEGES MASTER IN 1995 1992 1995
BUSINESS
ADMINISTRATION

(Continue on separate sheet if necessary)

Page 1 of 4
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
MAY
CULTURAL COMMUNITY OFFICER TUGUEGARAO CAGAYAN 30,
1980
AUGUS
AGRICULTURIST MANILA CITY 0005205 T 10,
2006

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE

30. INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / SALARY GRADE

(mm/dd/yyyy) POSITION TITLE MONTHLY & STEP STATUS OF
COMPANY SALARY INCREMENT APPOINTMENT
(Write in full)
(Write in full) (Format "00-0")
From To
(Yes /
01/01/2010 TO DATE AGRICULTURIST I LOCAL GOVERNMENT UNIT PERMANENT No)
YES

01/01/2009 12/31/2009 AGRICULTURIST I LOCAL GOVERNMENT UNIT PERMANENT YES

07/01/2008 12/31/2008 AGRICULTURIST I LOCAL GOVERNMENT UNIT PERMANENT YES

07/01/2007 06/30/2008 AGRICULTURIST I LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/2006 06/30/2007 AGRICULTURIST I LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/2003 12/31/2005 AGRICULTURIST I LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/2002 12/31/2002 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/2001 12/31/2001 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/2000 12/31/2000 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1999 12/31/1999 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1998 12/31/1998 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

11/01/1997 12/31/1997 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

09/01/1997 10/31/1997 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1997 08/31/1997 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1996 12/31/1996 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1995 12/31/1995 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1994 12/31/1994 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

04/01/1993 12/31/1994 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1993 03/31/1993 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

01/01/1992 12/31/1992 AGRICULTURAL TECHNOLOGIST LOCAL GOVERNMENT UNIT PERMANENT YES

(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 2 of 4
V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE
30. INCLUSIVE DATES
(mm/dd/yyyy) DEPARTMENT / AGENCY / OFFICE / SALARY GRADE
POSITION TITLE MONTHLY & STEP STATUS OF
COMPANY SALARY INCREMENT APPOINTMENT
(Write in full)
(Write in full) (Format "00-0")
From To
(Yes /
No)
01/10/1991 12/31/1991 AGRICULTURAL TECHNOLOGIST DEPARTMENT OF AGRICULTURE 3,164.00 PERMANENT YES

01/01/1990 08/31/1991 AGRICULTURAL TECHNOLOGIST DEPARTMENT OF AGRICULTURE 3,133.00 PERMANENT YES

07/01/1989 12/31/1989 AGRICULTURAL TECHNOLOGIST DEPARTMENT OF AGRICULTURE 3,102.00 PERMANENT YES

07/01/1988 06/30/1989 AGRICULTURAL TECHNOLOGIST DEPARTMENT OF AGRICULTURE 1,778.00 PERMANENT YES

01/01/1988 06/30/1988 AGRICULTURAL TECHNOLOGIST DEPARTMENT OF AGRICULTURE 1,458.00 PERMANENT YES

03/01/1987 12/31/1987 AGRICULTURE FOOD TECHNOLOGIST MINISTRY OF AGRICULTURE 1,251.58 PERMANENT YES

09/01/1985 02/28/1987 AGRICULTURE FOOD TECHNOLOGIST MINISTRY OF AGRICULTURE 1,042.91 PERMANENT YES

01/01/1985 08/31/1985 FARM MANAGEMENT TECHNILOGIST MINISTRY OF AGRICULTURE 813.00 PERMANENT YES

05/01/1984 12/31/1984 FARM MANAGEMENT TECHNILOGIST MINISTRY OF AGRICULTURE 736.00 PERMANENT YES

03/01/1981 04/30/1984 FARM MANAGEMENT TECHNILOGIST BUREAU OF AGRI. EXTENSION 666.00 PERMANENT YES

08/02/1980 02/28/1981 FARM MANAGEMENT TECHNILOGIST BUREAU OF AGRI. EXTENSION 603.00 PERMANENT YES

08/02/1979 08/01/1980 FARM MANAGEMENT TECHNILOGIST BUREAU OF AGRI. EXTENSION 603.00 TEMPORARY YES

08/02/1978 08/01/1979 FARM MANAGEMENT TECHNILOGIST BUREAU OF AGRI. EXTENSION 506.00 TEMPORARY YES

08/02/1977 08/01/1978 FARM MANAGEMENT TECHNILOGIST BUREAU OF AGRI. EXTENSION 517.00 TEMPORARY YES

05/11/1977 07/31/1977 SUPERVISING CROP TECHNICIAN RURAL BANK OF MAGSAYSAY 12.00/Day TEMPORARY YES

11/01/1970 11/30/1971 CAMPAINING CLERK 920 w/a TEMPORARY YES

TREASURER'S OFFICE STO.
TOMAS, ISABELA

/ / / /
(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
INCLUSIVE DATES
31. NAME & ADDRESS OF ORGANIZATION NUMBER OF
(Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From 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 NUMBER OF CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To
EXTENSION DELIVERY SYSTEM FOR MUNICIPAL AGRICULTURAL TRAINING
01/18/2010 03/19/2010 16
AGRICULTURIST INSTITUTE RTC SAN MATEO

09/24/2003 09/25/2003 16 PHILRICE SAN MATEO, ISABELA

SEED CERTIFICATION ON HYBRID RICE STRENGTENING DA-
LGU LINKAGE TRAINING WORKSHOP AGRI. TRAINING INST.RTCRD &
05/22/2002 05/24/2002 24
DEPT. OF AGRICULTURE
RETOOLING OF AGRICURAL TECHNOLOGIST ON RICE AGRICULTURAL TRAINING
03/29/2001 03/31/2001 24
PRODUCTION INSTITUTE RTC - RD

HYBRID SEED PRODUCTION UNIVERSITY WITHOUT WALLS 01/27/2000 03/15/2000 384 PHILRICE SAN MATEO, ISABELA

AGRICULTURAL TRIANING
SEED INSPECTOR'S REFRESHOR COURSE 11/04/1998 11/06/1998 24
INSTITUTE SAN MATEO, ISABELA
SPECIALIZED TRAINING COURSE ON HYBRID RICE SEED AGRICULTURAL TRAINING
08/26/1997 08/29/1997 32
PRODUCTION INSTITUTE SAN MATEO, ISABELA
GINTONG ANI CORN PRODUCTION, RETOOLING OF AGRICULTURAL TRAINING
05/09/1996 05/11/1996 24
AGRICULTURAL TECHNOLOGIST INSTITUTE RTC-RD
AGRICULTURAL TRAINING
TRAINING ON POST HARVEST TECHNOLOGY 11/21/1994 11/23/1994 24
INSTITUTE RTC-RD
AGRICULTURAL TRAINING
SEED INSPECTOR'S TRAINING 03/10/1993 03/12/1993 24
INSTITUTE SAN MATEO, ISABELA
AGRIBUSINESS ENTREPRENEUR DEVELOPMENT AGRICULTURAL TRAINING
07/06/1992 07/10/1993 40
MANAGEMENT TRAINING INSTITUTE SAN MATEO, ISABELA
CAG. VALLEY AGRICULTURAL
SOYBEAN PRODUCTION 11/14/1991 / / 8
RESEARCH CENTER
AGRICULTURAL TRAINING
TRAINING ON FARMING SYSTEM AS ENTERPRISE TO CARP II 09/23/1990 09/29/1990 56
INSTITUTE RTC-RD
AGRICULTURAL TRAINING
RICE PRODUCTION ENHANCEMENT PROGRAM II 10/02/1989 10/03/1989 16
INSTITUTE SAN MATEO, ISABELA

/ / / /

(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)
TYPING, READING NEWSPAPERS OUTSTANDING SEED INSPECTOR YEAR 20002 MARRIAGE ENCOUNTER

PROVINCIAL AND REGIONAL CONTESTANT

"KABALIKAT NG MAGSASAKA AWARD"

YEAR 1984

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4
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
EXTENSION DELIVERY SYSTEM FOR MUNICIPAL AGRICULTURAL TRAINING
01/18/2010 03/19/2010 16
AGRICULTURIST INSTITUTE RTC SAN MATEO

09/24/2003 09/25/2003 16 PHILRICE SAN MATEO, ISABELA

SEED CERTIFICATION ON HYBRID RICE STRENGTENING DA-
LGU LINKAGE TRAINING WORKSHOP AGRI. TRAINING INST.RTCRD &
05/22/2002 05/24/2002 24
DEPT. OF AGRICULTURE
RETOOLING OF AGRICURAL TECHNOLOGIST ON RICE AGRICULTURAL TRAINING
03/29/2001 03/31/2001 24
PRODUCTION INSTITUTE RTC - RD

HYBRID SEED PRODUCTION UNIVERSITY WITHOUT WALLS 01/27/2000 03/15/2000 384 PHILRICE SAN MATEO, ISABELA

SEED INSPECTOR'S REFRESHOR COURSE 11/04/1998 11/06/1998 24 AGRICULTURAL TRAINING

SPECIALIZED TRAINING COURSE ON HYBRID RICE SEED AGRICULTURAL TRAINING

08/26/1997 08/29/1997 32
PRODUCTION INSTITUTE SAN MATEO, ISABELA
GINTONG ANI CORN PRODUCTION, RETOOLING OF AGRICULTURAL TRAINING
05/09/1996 05/11/1996 24
AGRICULTURAL TECHNOLOGIST INSTITUTE RTC-RD
AGRICULTURAL TRAINING
TRAINING ON POST HARVEST TECHNOLOGY 11/21/1994 11/23/1994 24
INSTITUTE RTC-RD
AGRICULTURAL TRAINING
SEED INSPECTOR'S TRAINING 03/10/1993 03/12/1993 24
INSTITUTE SAN MATEO, ISABELA
AGRIBUSINESS ENTREPRENEUR DEVELOPMENT AGRICULTURAL TRAINING
07/06/1992 07/10/1993 40
MANAGEMENT TRAINING INSTITUTE SAN MATEO, ISABELA
CAG. VALLEY AGRICULTURAL
SOYBEAN PRODUCTION 11/14/1991 / / 8
RESEARCH CENTER
AGRICULTURAL TRAINING
TRAINING ON FARMING SYSTEM AS ENTERPRISE TO CARP II 09/23/1990 09/29/1990 56
INSTITUTE RTC-RD
AGRICULTURAL TRAINING
RICE PRODUCTION ENHANCEMENT PROGRAM II 10/02/1989 10/03/1989 16
INSTITUTE SAN MATEO, ISABELA
/ / / /
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees): YES NO

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): YES NO

appointing authority or recommending authority where you will be appointed? 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 YES NO
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, YES NO
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)? YES NO
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? YES NO

If YES, please specify: ____________________
b. Are you differently abled? YES NO
If YES, please specify: ____________________
c. Are you a solo parent? YES NO
If YES, please specify: ____________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

Computer generated
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and or xerox copy of picture
is not acceptable
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

13439623
COMMUNITY TAX CERTIFICATE NO.

ROXAS, ISABELA
ISSUED AT SIGNATURE (Sign inside the box)

01/05/2010
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

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