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 FIRS NAME MIDDLE NAME 4. DATE OF BIRTH (mm/dd/yy) 5. PLACE OF BIRTH 6. SEX 7. CIVIL STATUS

B E B O S O E R N E S T Q U I J A N O
February 1, 1974 PAGADIAN CITY
16. RESIDENTIAL ADDRESS

J O Y
3. NAME EXTENSION (e.g. Jr., Sr.)

N/A

0235 LUMBIA DISTRICT, PAGADIAN CITY ZAMBOANGA DEL SUR REGION 9

Male Single

Female Widowed Separated Others, specify

ZIP CODE 17. TELEPHONE NO. 18. PERMANENT ADDRESS

7016 N/A
0235 LUMBIA DISTRICT, PAGADIAN CITY ZAMBOANGA DEL SUR REGION 9

/
8. CITIZENSHIP 9. HEIGHT (m) 10. WEIGHT (kg) 11. BLOOD TYPE 12. GSIS ID NO. 13. PAG-IBIG ID NO. 14. PHILHEALTH NO. 15. SSS NO.

Married Annulled

FILIPINO 1.75 METERS 89 KLG O N/A N/A N/A N/A ALCANO BEMIA SNOOKY RAAGING STUDENT N/A N/A N/A
(Coninue on separate sheet if necessary)

ZIP CODE 19. TELEPHONE NO. 20. E-MAIL ADDRESS (If any) 21. CELLPHONE NO. (If any) 22. AGENCY EMPLOYEE NO. 23. TIN

7016 N/A N/A 9225802491 9-04-1788 920-754-278

DATE OF BIRTH (mm/dd/yyyy)

II. FAMILY BACKGROUND

24. SPOUSE'S NAME FIRST NAME MIDDLE NAME OCCUPATION EMPLOYER/BUS. NAME BUSINESS ADDRESS TELEPHONE NO. 26. FATHER'S SURNAME FIRST NAME MIDDLE NAME 27. MOTHER'S MAIDEN NAME SURNAME FIRST NAME MIDDLE NAME 25. NAME OF CHILD (Write full name and list all)

BEBOSO JESSE DEMAPINDAN QUIJANO ADORINA FERARREN

DAVE LAURENCE S BEBOSO N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

May 13, 1994 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

(Coninue on separate sheet if necessary) YEAR HIGHEST GRADE/ INCLUSIVE DATES OF SCHOLARSHIP/ CEGREE COURSE GRADUATED LEVEL/ ATTENDANCE ACADEMIC HONORS (Write in full) (If graduated) UNITS EARNED RECEIVED From To (If not graduated)

III. EDUCATIONAL BACKGROUND

28 LEVEL NAME OF SCHOOL (Write in full)

ELEMENTARY SECONDARY VOCATIONAL/

TOMAS SAGUN ELEM. SCHOOL

ELEMENTARY SECONDARY N/A

1987 1991 N/A

N/A N/A N/A

SY 81-82 SY 86-87 SY 87-88 SY 90-91 N/A N/A

N/A N/A N/A

ZSSAT
N/A

TRADE COURSE

N/A

N/A

N/A

N/A

N/A

N/A

N/A

COLLEGE

CEBU AERONAUTICAL TECH. SCHOOL

BSAeE

1996

184 UNITS

SY 92-93 SY 95-96

N/A

GRADUATE STUDIES

N/A

N/A

N/A

N/A

N/A

N/A

N/A

(Continue on separate sheet if necessary)

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

29 CAREER SERVICE/ RA 1080 (BOARD/BAR) UNDER SPECIAL LAWS/ CES/ CSEE RATING DATE OF EXAMINATION/ CONFERMENT PLACE OF EXAMINATION / CONFERMENT LICENSE (If applicable) NUMBER DATE OF RELEASE OCT. 19, 2005

CIVIL SERVICE FIRE OFFICER N/A N/A N/A N/A N/A N/A

81.10% N/A N/A N/A N/A N/A N/A

AUG. 14, 2005

CAGAYAN DE ORO CITY N/A N/A N/A N/A N/A N/A

05-001138 N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30 INCLUSIVE DATES (mm/dd/yyyy)
From To

POSITION TITLE (Write in full)

DEPARTMENT/AGENCY/OFFICE/COMPANY MONTHLY (Write in full) SALARY

SALARY GRADE & STEP STATUS OF INCREMENT APPOINTMENT (Format "00-0")

GOV'T SERVICE (Yes/No)

1-Jul-10 1-Jul-09 1-Apr-09 1-Jul-08 1-Jan-07 1-Jan-06 20-Jul-05 1-Jan-05 1-Jan-04 1-Jan-03 26-Aug-02 16-Apr-02 23-Jan-02 1-Jul-01

27-May-11 30-Jun-10 30-Jun-09 31-Mar-09 30-Jun-08 31-Dec-06 31-Dec-05 19-Jul-05 31-Dec-04 31-Dec-03 31-Dec-02 25-Aug-02 15-Apr-02 22-Jan-02

F02/DRIVER F02/DRIVER F02/DRIVER F01/DRIVER F01/DRIVER F01/DRIVER F01/DRIVER F01/DRIVER F01/DRIVER F01/DRIVER F01/DRIVER FO1/PSBRC TRAINEE FO1/DRIVER FO1/DRIVER

BFP, PAGADIAN FIRE STATION BFP, PAGADIAN FIRE STATION BFP, PAGADIAN FIRE STATION BFP, PAGADIAN FIRE STATION BFP, PAGADIAN FIRE STATION BFP, PAGADIAN FIRE STATION BFP, PAGADIAN FIRE STATION SANTIAGO FSS, PAGADIAN CITY SANTIAGO FSS, PAGADIAN CITY SANTIAGO FSS, PAGADIAN CITY SANTIAGO FSS, PAGADIAN CITY FNTI, CALAMBA, LAGUNA LUMBIA FSS, PAGADIAN CITY LUMBIA FSS, PAGADIAN CITY

13,785 12,210 10,466 9,466 8,605 8,605 6,695 6,695 5,987 5,775 5,775 5,775 5,775 5,775

I2-2 I2-2 1O-1 1O-1 1O-1 1O-1 1O-1 1O-1 1O-1 6-O 6-O 6-O 6-O 6-O

PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT

YES YES YES YES YES YES YES YES YES YES YES YES YES YES

1-Dec-00 10-Oct-00 1-Jan-00 10-Dec-99 1-Dec-99 2-Aug-99 N/A N/A N/A N/A N/A N/A

30-Jun-01 30-Nov-00 9-Oct-00 31-Dec-99 9-Dec-99 30-Nov-99 N/A N/A N/A N/A N/A N/A

FO1/NOZZLEMAN/DRIVER FO1/DRIVER FO1/ALT. DRIVER FO1/ALT. DRIVER FIRE OFFICER 1 FO1/ PSBRC ORIENTATION N/A N/A N/A N/A N/A N/A

LUMBIA FSS, PAGADIAN CITY LUMBIA FSS, PAGADIAN CITY KOLAMBUGAN FS,LDN KAPATAGAN FS, LDN ORFM, BFP R-9 BFP, NATIONAL OFFICE N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)

5,500 5,500 5,500 5,000 5,000 5,000 N/A N/A N/A N/A N/A N/A

6-O 6-O 6-O 6-O 6-O 6-O N/A N/A N/A N/A N/A N/A

PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT PERMANENT N/A N/A N/A N/A N/A N/A

YES YES YES YES YES YES N/A N/A N/A N/A N/A N/A

CS FORM 212 (Revised 2005), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31 NAME & ADDRESS OF ORGANIZATION (Write in full) INCLUSIVE DATES (mm/dd/yyyy NUMBER OF HOURS POSITION / NATURE OF WORK

N/A N/A N/A N/A N/A VII. TRAINING PROGRAMS (Start from the most recent training.)
32 TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full)

N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

INCLUSIVE DATES OF ATTENDANCE (Write in full)

From To

NUMBER OF HOURS

CONDUCTED/ SPONSORED BY (Write in full)

PUBLIC SAFETY BASIC RECRUIT COURSE

N/A N/A N/A N/A N/A N/A N/A N/A

04/16/02 N/A N/A N/A N/A N/A N/A N/A N/A

08/16/02 N/A N/A N/A N/A N/A N/A N/A N/A

640 N/A N/A N/A N/A N/A N/A N/A N/A

FIRE NATIONAL TRAINING INSTITUTE

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A VIII. OTHER INFORMATION

N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

NON-ACADEMIC DISTINCTIONS / RECOGNITION 32 SPECIAL SKILLS / HOBBIES 34 (Write in full) 35

MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)

DRIVING PLUMBING ELECTRICAL WIRING N/A N/A N/A

N/A TESDA N/A N/A N/A N/A

(Continue on separate sheet if necessary)

N/A N/A N/A N/A N/A N/A

CS FORM 212 (Revised 2005), Page 3 of 4

36. Are you related by consanquinity or affinity to any of the following: a. Within the third degree (for National Government Employees): appointing authority, recommending authority, chief of office/bureau/department or person who has immediate supervision over you in the Office, Bureau or Department where you will be appointed? YES NO

If YES, give details

N/A N/A N/A

b. Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed?

YES

If YES, give details

NO

N/A N/A N/A

37. a. Have you ever been formally charged? YES If YES, give details

NO

N/A N/A
b. Have you ever been guilty of any administrative offense? YES If YES, give details NO

N/A N/A
38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal? YES

If YES, give details

NO

N/A

N/A
39. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the rolls, dismissal, termination, end of term, finished contract, AWOL or phased out, in the public or private sector? YES

If YES, give details

NO

N/A N/A

40. Have you ever been a candidate in a national or local election (except Barangay election)?

YES

If YES, give details

NO

N/A N/A
41. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: a. Are you a member of any indigenous group? b. Are differently abled? c. Are you a solo parent? YES YES YES

If YES, please specify: If YES, please specify: If YES, please specify: 42. REFERENCES (Person not related by consnquinity or affinity to applicant / appointee) NAME ADDRESS TEL. NO.

/ / /

NO

N/A N/A N/A

NO NO

ERIC M. BAJAO ROY ANTHONY D. PADUA

DAO, PAGADIAN CITY SUNRISE, PAGADIAN CITY

N/A N/A N/A

ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size)

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philipiines.
Computer generated or xerox copy of picture is not acceptable

I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this information shall remain confidential.
PHOTO

1094334
COMMUNITY TAX CERTIFICATE NO.

LUMBIA, PAGADIAN CITY

ISSUED AT SIGNATURE (Sign inside the box)

January 21, 2011

ISSUED ON (mm/dd/yyyy)

May 27, 2011

DATE ACCOMPLISHED
RIGHT THUMBMARK CS FORM 212 (Revised 2005), Page 4 of 4

up by CSC)

/A

mm/dd/yyyy)

994

OLARSHIP/ MIC HONORS CEIVED

N/A

N/A

N/A

N/A

N/A

N/A

age 1 of 4

plicable)

DATE OF

RELEASE

CT. 19, 2005

N/A N/A N/A N/A N/A N/A

GOV'T SERVICE (Yes/No)

YES YES YES YES YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES N/A N/A N/A N/A N/A N/A

age 2 of 4

WORK

ED BY

STITUTE

ZATION

, Page 3 of 4

, Page 4 of 4