Navotas City Hal.

I
[Link] st, Navotas 1485, Metro Manila,

Attention to: HR Department

Dear sir/Madam,

I humbly wish to apply for the position as Security Personnel as was advertised on the
company's facebook page.

I believe that my experienced in my served as "Tanod on Duty" at Brgy. North Bay

Boulevard South Proper (NBBS) and my years as resident of Navotas City will help me to be

qualified for the said position.

I am looking forward to consider my application and to work with you soon. God bless!

Respectfully yours,
CS Form No. 212
Aev'sed2o" pERSoNAL DATA SHEET

"ARNING: Any mtstaptes®ntation. made in thle Persoi\al Date Sheet and the Work ExpeTienc® Sheet shall calLse ike tlllng Of ac!mlnlstet]velcrimlnei case;s agalF\st thle peTsson
concerned.
TO FILLING Our THE PERSONAL DAITA SI+EET (PDSI BEFORE ACCOMFELISHING TIIE PDS FOF\M
Pnnt edlblv` Tick approDnate hoxesr] ) and use separate shat if necessary. Indicate N/A rf not al]Dlicable. DO NO ABBREVIATE. Itv.'SPca `] (Do nol fil up. For csc use only)
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i`:',rY§.,[Link]??3B::|¢:'ffi``*&^`{`r``P'_'`rJ`;`.:
ffl /.-'ae3j*3}<``:-_.J`-`, .:t¥ .,`J *,tg,`*S: SS,---i*#-e£%,`t,#E1..,SSS ::,-,_ ,,` , ,`--..-,,,(:-,:-`::,,,I-_,:

2. SUR"EFIRSTNAMEMDDLENAME 6 I Du cot
NAME EXTENSION (JR.. SR)

apE|
\ u'StR' £ ' who
3, DATE OF BIR"(mm/dd/yyyy)
16. cITEENsm3
ErFillpino E Dualouzenship
Ou I a.¢ I o8
gbyblrth Dbymat(irali7ation

4. PLACE OF BItTH CEOu ff tfty Of dual ctizen§hip, Pis. indicate country:

II,

pbe ndiee!e the detaits.

5. SEX EJ Male I Fenale
17. RESIDENTIAL ADDRESS
6 civii sTAT`rs I single F MarriedIwidowedEseparatedEother/s:
House/BIcokiLoi No. - ` s[real

SubdiuslonNilleae - ` Bat;inaEiv

7. HEIGHT (in) s'5 ".'=

8. WEICHT (kg) 2o lb£. ZIP CODE

9` BLOOD TYPE 0 18 PERMANENT AODRESSZIPCODE 52J ,L"€. ,t^, 6£r.

IlouselBbeklto! No. ' ' Sticet

10. GSIS ID NO.

- Subdi\iisiohlvilrcae ` --
Pb8[ PR®PeF<
tsr€naev ~

11. FAG-`BIG ID NO,

- NH®ms ctng
CrtylMrindrdiv- ' I ". -
Me+to MAN I ur
.i>rovirice

12. PHILHEALTH NO. 2. -co1152 +.€ -W '1Oq

13. SSS NO. a, -q35yq92 -i 19 TELEPHONE NO.

14. TIN NO. 20. MOBRE NO. Oq218b5tap4

15. AGENCY EMPLOYEE NO. 21. E-RAL ADDRESS (if any)

22. SPOUSE'S SURNAMEFff`ST"EMH)DLENAME 23 NAME Of CHILDREN owrfe ful name and ist aD DATE OF BIRTH (mrn/dd/yyyy}
61 Du cJ>S
HARE EXTENsiou (jR , sR)
TrriE±N^ Nv+€ 6IOuc.I 1® le, lqv
Pe^' A,
„oO*L® "N OI+E. O®| 6IOuCL\t „ l'a I ap
OCCUPATION olET.n*N I cto« gruEw~ 6i]>ucoj ro lou lq1
EMPLOYER/BUSINESS NAME MC. JT`ys.^ 6lc>ucO( ®Q h 0' 1®®
C6R.^GEs) ®ueg.N CIT3|
BUSINESS ADDRESS €o.®eu *cR€s R.D . .^6o 8+NT*1, ®C.
TELEPHCINE NO (02.) 8q2q"g2
24. FATHER'S SuRNAMEFIRST}IAMEMIDOLE"E C' Ou c® {
NAm: EXTENsion (jR., sR)
+~[Link]
VEC'6+W'®

25. roTHERS MAIDEN NAME

SUR!VAMEFIRSTNAMEMIDDLENAME €'OuC® S

AI F ~ I t+
\ u'srm 3 I Nb (Ct}Tltinue on [Link] sheet lf necessary)
'...-.:.-. -I.!,i;i(SIT.;.kiJ •,f>,il-.;+:,.,,
: ., , .,I,I( ,-:--,A -

SCHOLARSHIP/ACADEMIC
HIGHEST LEVEL/N
26 NAME OF SCHOOL BASX: E0uCA"ON/DEGREE/COURSE PERIOD OF ATTENDANCE YEAR
|EVEL u msEARNED(Ifnotgraduated)
(Wrtie in fun que in fufty GRADUATED I+ONC'RSRECEIVED

Frm To

EtiMEiurARy
NOon ng givi€coFlew.£croL 'q7S-I

SECONDAftY nf<. j€e6io asAi`EXA.I..,,, 'q8'-'q

VOCATIONAL /[Link]
j"(orb WjTitittE of tGcmb Y PfzAroncAr|I;I-cert'Cm' Iqq'rty
I

COLLEGE

GRADUATE STUDIES

{Conyique ot. separate cheel il necessary)

•\ , DATE
SIGNATURE quwE D5 a e.13
`1 ( ) esFORM2iz(Revled2biT) penld4
 -I ,,I- ` EEEi- i!, - , , ,,

llcENSE (if applicable)

27. CAFiEEFZ SERVICE/ RA 1080 @OARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAwllNATION / PLACE OF EXAMINATION / CONFERMENT Date Of
(IfAppeble) NUMBER
BARANGAY ELIGIBILITY / ORIVER'S LICENSE CONFERMENT Vdidfty

(CoTith ue on separde sheet if necessary)

i,\v!,I {`;:,i:: \(:-:I ;,:: E '`` r`IiT3! 7;i :i)_,\:'!'..`,i

`l:I.:.i,[Link],:i;i_i=,,-:I::;:`,,' • ,
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-[Link]^*!l

28. INCLUSIVE DATES(mndddfyyyy) COVT

GRADE (ff
posmoN TiTiE DEF'AF"ENT / AGENCY / OFFICE / COMPANY wromLy STATUS OF
qprHSTEP([Link].}'HCREMENT §EfMCE('''N)
Owrfe in full/Do not abbreviato) SALARY AppotNTneNT
nyrito in fultoo not abbreviate)
From To

Joa' PRg!Enr &R.I. pcne/tRDca I T^toD BReY- Hb&£ FT®F*F? a, tco

SIGMTURE
'-- -
..I...--..I

DATE GUNE 05?2^Z}

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-i:i,.`,)-lJ='-;.,I,\:A,!!:-I:,I,I-=v?..`;.`'±,.-`.\!`,,I-}=J

lNCLUSJVE DATES
29 NAME & ADDRESS OF ORGAN RATION
(WTto h fun
(in-) unBERcFHus posmoN ; NATURE OF WORK

From To

(Continue on [Link] sheet tt rlecessory)

•`:,:i;-'`-`I-=,I,.^\!;I,`t:'i-\!f±',',i\`,::=,',.~.::.:`5\t:',:.fli=t`:i:'9r,`,F:frii:i.::.':I.i.'i`,-`!.,A I
lNCLUSIvt l)A I ts 0LATTENDANCE 1'ypeOf|D(Mangiv
so` TrrLE OF LEARNING AND DEVELopMENT iNTERVENTioNsrmAINING PRcx3RAMs CONDUCTED/ Spol`lsoRED 8Y
NLAi8ER or HcxjFrs
(wife in fun (mmAldtw) [Link]'eto) Owrfe h fun

From To

f*tFtoLL,w6 A+It> Faeipouse ceR4tiorif ng+iww< /?4/a, `,12¢12\ PNP /Pol,cE -~PD
J [Link] 1` , . , ``. , , -. -1--

I I I I

|Corltinue en separa'.e st.e€t if Tiecessery)

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r ,,,#'±i
}ycffi;H#:;:#FfRE;*^.a)-.`+`.+.`(i,

NOW-ACADErmc oisT*icTroNs / REccx3NmoN

31. SPECIAL SKILLs and HOBBIES 32` (\me n ful) 33 MEMBERSHIP IN ASsOCIATIChL/ORGANIATtchlqunfuD

_ {Cont:|n}±&SEi..parole shcel rfnecossery)

SIGRATURE
Levy
- \j
DATE au uE 0 s, hoz3
cS FOF" 212 (F3e`flsed 2J]17), Pap 3 of 4
34. Are you reletod by consanguinfty or affinfty to the appointing or recommending authorty, or to the
chief of bureau or office or tc the person who has immediate supervision over you in the Office,
Bureau or DepaTthent whore you wll be apppointBd,
a. within the third degree?

b. \^thin the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:

35` a. Have you ever been found guifty Of any administrative offense? I yEs IVNo
lf YES, give details:

b. Have you been orimjnally charged before any court? I YES D

lf YES, give details:
NO

Date Filed:

Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by
any court or tribunal?
I YES
lf YES, give defaiis.

37. Have you ever been separated from the sewice in any of the folk]wing modes: rosisnafron, retirement,
E yES PNo
dropped from the rolls, dismissal, termination, end of torn, finished contract or phased out (abolfron) lf YES, give details:
in the piiblic or private sector?

38. a Have you ever been a candidate in a national or k)cal ol®ction herd within the last year ([Link]
Barangay eketon)?
I YES

i
lf YES, give details:

b. Have you resisned from the government serviee during the throe (3}month period before the fast YES

etecton to promote/adively campaien for a national or k]cal candidate? lf YES, give details:

39. Have you acquired the statLJs Of an immisrant or permanent resident of another country?
D YES
lf YES, give details (country):

40` Pursuant to: (a) lndjgenoiis People's Act (RA 8371 ); (b) Magna Carta for Disabkrd Persons (RA 7277);
and (c) Soto Parents Welfare Act of 2000 (RA 8972), please an§ver the fohowing ifems:
a Areyou amemberofanyind©enous group?
I YES
lf YES, please specfty:
Ezl NO
b. Are youaperson whhdisabilfty?
I YES
lf YES, please specfty lD No:
c. Areyouasoloperent?
E yEs dNo
lf YES, please specify lD No:

41. REFERENCES (Person not related by con3angiiin]ty or affinlty to applicant /appetntee)

ADDRESS

M+41K Firi.+lpHV [Link]^Im. " a..ng ouEap crg oqiqon q 2qT

42. I dechre under oath that I have personally accomplished this Peisonal Data Sheet whieh is a true, correct and
complete statement pursuant to the provisions of pertinent lams. mules and regulatons of the Republie of the
Philippines. I authorize the agency head/authorized representatwe to vertyiv8lidafe the contents stated herein. I
agree that any iTiisrepresentation made in this document and its attachments shall cause the filing of
ad min istrative/criminal case/s again st me.

Government Issued I D (I.a.pa5sm eels. SSS, PRC. Dwers Licoree. etc.)

PLEASE INDICATE ID Number end Ode Of lssuenoe

Government lssued lD. J <j

/
(OfLnei`[Link]®spatNo. a. -q3Sy q8? -I
` Siqgivire (Sisn in&de ttryfrox)

Datemaceonssuarice.. aoo8 ( "n -JllRow.I)

" E h a . _2D > ®
Date Accomptshed

SIJBSCRIBED AND SWORN to before me this affient exhrmg hjsiner valifty issued government lD as indicated above

Person Administering Oath

CS FORM 212 (Revised 201n, Page 4 Of 4

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 Certifitcate Of Atterrdcmce
JOEL L. GIDUCOS
For having attended and satisfactory completed the Program of
Instructions (Pol) of the ,¥_atrolling and `¢.::[Link] &perations
`{taining to ;I,`mpower £=VOs and ;{;anods ([Link]£SnT. ¥.€tl"f)
concluded from fu~ovember 24, 25 and 26, 2021.

Given this 26th day of November 2021 at Navotas City Headquarters,

M. Naval St., Barangay Sipac -Almacen, Navotas City.

"SerbisyongTI4Sfl4Tl4pat,maytapangatMA___!asakjtparasamamamayan"