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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET


Print legibly. Mark appropriate boxes

with "

1. CS ID No.

" and use separate sheet if necessary.

(to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME
FIRST NAME
MIDDLE NAME

CORTES
MELJUN
PATATAG

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

10/02/1975

4. DATE OF BIRTH (mm/dd/yyyy)


5. PLACE OF BIRTH

16. RESIDENTIAL ADDRESS

#143 Dr. Pilapil St., San Miguel, CITY OF PASIG,


NCR SECOND DISTRICT

PAGADIAN City, Zamboanga Del Sur, Region 9

6. SEX

Male

7. CIVIL STATUS

Single

Widowed

Married

Separated

17. TELEPHONE NO.

Annulled

Others, specify ___________

18. PERMANENT ADDRESS

8. CITIZENSHIP

Filipino

9. HEIGHT (m)

168 cm

10. WEIGHT (kg)

62 kg

11. BLOOD TYPE

O+

Fem ale
ZIP CODE

#0344 Purok Marang, Tuburan District, PAGADIAN CITY (Capital),


ZAMBOANGA DEL SUR
ZIP CODE

12. GSIS ID NO.


13. PAG-IBIG ID NO.
14. PHILHEALTH NO.
15. SSS NO.

1600

90210813903
150500919096
10-0467382-7

7016

19. TELEPHONE NO.

063-062-2143528

20. E-MAIL ADDRESS (if any)

meljuncortes@gmail.com
09309705704

21. CELLPHONE NO. (if any)


22. AGENCY EMPLOYEE NO.

911-012-503

23. TIN

II. FAMILY BACKGROUND


25. NAME OF CHILD (Write full name and list all)

24. SPOUSE'S SURNAME

DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
(Continue on separate sheet if necessary)

CORTES (Deceased)
LUIS Sr.

26. FATHER'S SURNAME


FIRST NAME

ESCANUELA

MIDDLE NAME
27. MOTHER'S MAIDEN NAME

PATATAG (Deceased)

SURNAME

CARMELITA

FIRST NAME

ARANTE

MIDDLE NAME

III. EDUCATIONAL BACKGROUND


28.
LEVEL

NAME OF SCHOOL
(Write in full)

DEGREE COURSE
(Write in full)

YEAR
GRADUATED

(if graduated)

HIGHEST GRADE/
LEVEL/UNITS
EARNED
(if
not graduated)

INCLUSIVE DATES OF ATTENDANCE


From

To

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

ELEMENTARY

Balangasan Central School

Primary Education

1989

1983-06-10

1989-03-27

1st Honorable
Mention

SECONDARY

Holy Child Academy (HCA)

Secondary Education

1993

1989-06-05

1993-03-25

10th Honorable
Mention

Saint Columban College (SCC)

Associate in
Computer Science

1995

1993-06-05

1995-03-26

PESFA Scholar

Butuan City Colleges (BCC)

CHS NC II 396 hours Computer Hardware Servicing

2009

2009-02-28

2009-05-24

GMA Scholar
(STEPS)

Saint Columban College (SCC)

Bachelor of Science in
Computer Science (BSCS)

1997

1993-06-05

1997-03-27

Academic
Distinction

Saint Columban College (SCC)

Master in Public
Administration (MPA)

2003

2000-06-10

2003-03-27

Grant Study

Southern Mindanao Colleges


(SMC)
Polytechnic University of the
Philippine (PUP)

Master in Business
Administration (MBA)

2000

1997-06-10

2000-10-27

Grant Study

Master of Science in
Information Technology
(MSIT)

24 units

2016-05-10

Present

AMA Computer University

Master of Science in
Computer Science (MSCS)

18 units

2011-06-10

2013-03-27

VOCATIONAL / TRADE
COURSE

COLLEGE

GRADUATE STUDIES

CORTES, MELJUN PATATAG - TCU (Taguig City University)

Self-Sponsored

CS FORM 212 (Revised 2005), Page 1 of 6