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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 R | O | D | R | I | G | U | E | Z | | | | | | | | | | | | | | | | | |

FIRST NAME C | E | S | A | R | | | | | | | | | | | | | | | | | | | | | | | |

MIDDLE NAME P | A | S | T | R | A | N | A | | | | | | | | | |3. NAME EXTENSION (e.g. Jr., Sr.) N/A


4. DATE OF BIRTH (mm/dd/yyyy) 04/14/1962 16. RESIDENTIAL ADDRESS

PHASE II, BLOCK I, LOT 10, CONGRESSVILLE SUBDIVISION,


5. PLACE OF BIRTH POTOTAN, ILOILO
MANGGAHAN, RODRIGUEZ, RIZAL
6. SEX Male Female
7. CIVIL STATUS 1860
Single Widowed ZIP CODE

Married Separated 17. TELEPHONE NO.

Annulled Others, specify ___________ 18. PERMANENT ADDRESS

8. CITIZENSHIP FILIPINO 109 SAN NICOLAS SUBDIVISION, NEW BUSWANG, KALIBO, AKLAN
9. HEIGHT (m) 1.63 m
10. WEIGHT (kg) 45 kg ZIP CODE 5500
11. BLOOD TYPE O 19. TELEPHONE NO. (036) 2621048
12. GSIS ID NO. B62GECPR011 20. E-MAIL ADDRESS (if any) ceskalibo@yahoo.com
13. PAG-IBIG ID NO. 786677309 21. CELLPHONE NO. (if any) 09178913816
14. PHILHEALTH NO. 190000535617 22. AGENCY EMPLOYEE NO. S-O917
15. SSS NO. 0711190092 23. TIN 154828273
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME N/A 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/A / /


MIDDLE NAME / /
OCCUPATION N/A / /
EMPLOYER/BUS. NAME N/A / /
BUSINESS ADDRESS N/A / /
TELEPHONE NO. N/A / /
(Continue on separate sheet if necessary) / /
26. FATHER'S SURNAME RODRIGUEZ / /
FIRST NAME CRESENCIO SR. / /
MIDDLE NAME CORDERO / /
27. MOTHER'S MAIDEN NAME / /
SURNAME PASTRANA / /
FIRST NAME ELMA / /
MIDDLE NAME CHAVEZ (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 GUINACAS ELEMENTARY SCHOOL ELEMENTARY 1975 1970 1975 VALEDICTORIAN

HONORABLE
SECONDARY HOLY INFANT COLLEGE SECONDARY 1979 1975 1979
VOCATIONAL / MENTION

N/A
TRADE
COURSE
COLLEGE UNIVERSITY OF THE PHILIPPINES- BACHELOR OF SCIENCE
IN MANAGEMENT 1984 1980 1984
DILIMAN

GRADUATE STUDIES UNIVERSITY OF THE PHILIPPINES- DIPLOMA IN INDUSTRIAL


RELATIONS 1995 1993 1995
DILIMAN
UNIVERSITY OF THE PHILIPPINES- MASTERS IN INDUSTRIAL
RELATIONS 1997 1995 1997
DILIMAN
(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

CAREER SERVICE PROFESSIONAL 81.38% 08/03/1986 KALIBO, AKLAN

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work) GOV'T
SERVICE
30. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY GRADE
(mm/dd/yyyy) MONTHLY & STEP STATUS OF
SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To
(Yes / No)
HOUSE OF REPRESENTATIVES OFFICE OF
07/01/2009 06/30/2010 POLITICAL AFFAIRS ASSISTANT III HONORABLE FLORENCIO T. MIRAFLORES
P12,748.00 11-1 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


10/01/2008 06/30/2009 POLITICAL AFFAIRS ASSISTANT III HONORABLE FLORENCIO T. MIRAFLORES
P17,198 11-1 CO-TERMINUS YES

CONTRACTUA
07/01/2007 07/31/2007 LEGISLATIVE STAFF OFFICER II HOUSE OF REPRESENTATIVES P14,630.00 YES
L

HOUSE OF REPRESENTATIVES OFFICE OF


07/16/2005 06/30/2007 CHIEF POLITICAL AFFAIRS OFFICER HONORABLE FLORENCIO T. MIRAFLORES
P26,771.00 26-8 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


07/01/2004 07/15/2005 CHIEF POLITICAL AFFAIRS OFFICER HONORABLE EILLEN ERMITA-BUHAIN
P26,771.00 26-8 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


05/01/2003 06/30/2004 CHIEF POLITICAL AFFAIRS OFFICER HONORABLE EILLEN ERMITA-BUHAIN
P26,771.00 26-8 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


08/01/2001 04/30/2003 CHIEF POLITICAL AFFAIRS OFFICER HONORABLE WILHELMINO SY-ALVARADO
P26,771.01 26-8 CO-TERMINUS YES

SUPERVISING LEGISLATIVE STAFF CONTRACTUA


02/20/2001 07/31/2001 HOUSE OF REPRESENTATIVES P19,067.00 23-0 YES
OFFICER I L

CONTRACTUA
01/01/2000 12/31/2000 LEGISLATIVE STAFF OFFICER VI HOUSE OF REPRESENTATIVES P18,334.00 22-0 YES
L

CONTRACTUA
12/01/1998 12/31/1999 LEGISLATIVE STAFF OFFICER VI HOUSE OF REPRESENTATIVES P16,667.00 22-0 YES
L

HOUSE OF REPRESENTATIVES OFFICE OF


11/01/1997 06/30/1998 POLITICAL AFFAIRS OFFICER III HONORABLE ALLEN S. QUIMPO
P15,139.00 18-5 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


01/01/1997 10/31/1997 POLITICAL AFFAIRS OFFICER III HONORABLE ALLEN S. QUIMPO
P12,322.00 18-5 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


01/01/1996 12/31/1996 POLITICAL AFFAIRS OFFICER III HONORABLE ALLEN S. QUIMPO
P9,504.00 18-0 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


07/01/1995 12/31/1995 POLITICAL AFFAIRS OFFICER III HONORABLE ALLEN S. QUIMPO
P7,600.00 18-0 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


01/01/1995 06/30/1995 LEGISLATIVE STAFF OFFICER II HONORABLE ALLEN S. QUIMPO
P7,110.00 15-0 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


01/01/1994 12/31/1994 LEGISLATIVE STAFF OFFICER II HONORABLE ALLEN S. QUIMPO
P6,110.00 15-0 CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


02/01/1993 12/31/1993 LEGISLATIVE STAFF OFFICER II HONORABLE ALLEN S. QUIMPO
P5,410.00 N/A CO-TERMINUS YES

HOUSE OF REPRESENTATIVES OFFICE OF


07/01/1992 01/31/1993 LEGISLATIVE STAFF ASSISTANT II HONORABLE ALLEN S. QUIMPO
P4,112.00 N/A CO-TERMINUS YES

01/01/1992 6/30/1992 TIDS DEPARTMENT OF TRADE AND INDUSTRY - REGION VI CONTRACTUA


P4,418.00 N/A L YES
CONTRACTUA
07/01/1991 12/31/1991 TIDS DEPARTMENT OF TRADE AND INDUSTRY - REGION VI P3,975.00 N/A YES
L

CONTRACTUA
08/01/1989 06/30/1991 MTIO DEPARTMENT OF TRADE AND INDUSTRY - REGION VI P3,790.00 N/A YES
L
07/01/1983 07/01/1986 BOOKKEEPER/BUDGET OFFICER RURAL BANK OF BALETE - AKLAN P5,600.00 N/A REGULAR NO
(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

N/A / / / /

/ / / /

/ / / /

/ / / /

/ / / /
(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 NUMBER OF CONDUCTED/ SPONSORED BY
in full) (mm/dd/yyyy) HOURS (Write in full)
From To
3RD CONSULTATION-DIALOGUE WITH LEGISLATORS, CHIEF OF DEPARTMENT OF SOCIAL WELFARE AND
STAFF/TECHNICAL STAFF AND SELECTED P/C/MWSDOS 11/25/2004 11/25/2004 8 DEVELOPMENT -REGION IV-A (CALABARZON)

SEMINAR ON MEDIA RELATIONS FOR CONGRESSIONAL PUBLIC RELATIONS AND INFORMATION


10/22/2002 10/22/2002 4 DEPARTMENT, HOUSE OF REPRESENTATIVES
STAFF
HUMAN RESOURCE MANAGEMENT SERVICE,
BUDGET PROCESS SEMINAR 10/11/2001 10/11/2001 4 HOUSE OF REPRESENTATIVES

HUMAN RESOURCE MANAGEMENT SERVICE,


SEMINAR ON BILL DRAFTING 09/27/2001 09/27/2001 4 HOUSE OF REPRESENTATIVES

ORIENTATION PROGRAM FOR THE NEW LEGISLATIVE STAFF HUMAN RESOURCE MANAGEMENT SERVICE,
08/16/2001 08/16/2001 4 HOUSE OF REPRESENTATIVES
CHIEFS
ROUNDTABLE DISCUSSION WITH LEGISLATIVE CHIEFS-OF- INDIGENT PROGRAM GROUP, PHILIPPINE HEALTH
09/02/2000 09/02/2000 4 INSURANCE CORPORATION
STAFF
ORIENTATION WORKSHOP ON POPULATION, GENDER AND PHILIPPINE LEGISLATOR'S COMMITTEE ON
06/29/2000 06/29/2000 8 POPULATION AND DEVELOPMENT FOUNDATION
HUMAN DEVELOPMENT
HUMAN RESOURCE MANAGEMENT SERVICE,
SPEECH WRITING SEMINAR 04/28/2000 04/28/2000 4 HOUSE OF REPRESENTATIVES

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /
(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)
CERTIFICATE OF APPRECIATION, OPERATION SMILE CONGRESSIONAL STAFF
READING
PHILIPPINES FOUNDATION, INC. ASSOCIATION
CERTIFICATE OF APPRECIATION, PANELIST FOR THE FEASIBILITY STUDY UNIVERSITY OF THE PHILIPPINES
WRITING "ZONE VIDEO SHOP"NEW ERA UNIVERSITY ALUMNI ASSOCIATION
CERTIFICATE OF APPRECIATION, PANELIST OFR THE FEASIBILITY STUDY "CLASSICA ARCHBISHOP GABRIEL M. REYES
SWIMMING DORMITORY", NEW ERA UNIVERSITY FOUNDATION
CERTIFICATE OF APPRECIATION, ASSOCIATION OF LAW
STUDENTS OF THE PHILIPPINES-NCR

(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): 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: Expiration of contract

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.

GARCIA, GLADYS P. Proj.8, Quezon City 9189117911 ID picture taken within


the last 6 months
TABIGNE, GERMILA P. HOUSE OF REPRESENTATIVES 9315001 3.5 cm. X 4.5 cm
(passport size)
PATRON, IVAN,JR. KALIBO, AKLAN 9496934891
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
30025905
COMMUNITY TAX CERTIFICATE NO.

RODRIGUEZ, RIZAL
ISSUED AT SIGNATURE (Sign inside the box)

03/23/2010
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

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