Beruflich Dokumente
Kultur Dokumente
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME TALIB
NAME EXTENSION (JR., SR
FIRST NAME SITTIE ZAHRA
MIDDLE NAME ABUBAKAR
3. DATE OF BIRTH
(mm/dd/yyyy) 12/25/1998 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH COTABATO CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female
15. AGENCY EMPLOYEE NO. N.A. 21. E-MAIL ADDRESS (if any) sittiezahra16@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N.A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME N.A. N.A N.A.
ELEMENTARY EMAR LEARNING CENTER, DAVAO PRIMARY EDUCATION 2005 2011 GRADUATED
SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person
Dual Citizenship
by naturalization
N.A.
Street
BANUBO
Barangay
MAGUINDANAO
Province
9605
N.A.
Street
BANUBO
Barangay
MAGUINDANAO
Province
9605
N/A
09555912319
sittiezahra16@gmail.com
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SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
RANK 9
8TH
HONORABLE
MENTION
N.A. N.A.
N.A N.A.
N.A. N.A.
parate sheet if necessary)
6/17/2019 8/24/2019 TRAINEE R.R ENCABO CONSTRUCTORS INC. N.A N.A. N.A
SIGNATURE DATE
CS FORM 212 (Revised 20
LICENSE (if applicable)
Date of
Validity
N.A
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GOV'T
SERVICE
(Y/
N)
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arate sheet if necessary)
PHILIPPINE I
ENCODING N.A
WATCHING MOVIES N.A
AUTOCAD N.A
N.A
N.A
N.A
N.A
(Continue on separate sheet if necessary)
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
N.A
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N.A
eparate sheet if necessary)
ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)
CONDUCTED/ SPONSORED BY
(Write in full)
N.A
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MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
PHILIPPINE INSTITUTE OF CIVIL ENGINEERS - STUDENT
CHAPTER
N.A
N.A
N.A
N.A
N.A
N.A
35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
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
YES ✘ NO
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, YES ✘ NO
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 YES ✘ NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
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?
YES ✘ NO
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? YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.