Académique Documents
Professionnel Documents
Culture Documents
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME CALUNSAG
NAME EXTENSION (JR., SR
FIRST NAME EL NIÑO
4. PLACE OF BIRTH SAN CARLOS CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS SITIO
Widowed Separated House/Block/Lot No. S
Other/s: BULU
Subdivision/Village Ba
7. HEIGHT (m) 1.65m SAN CARLOS CITY NEGROS O
City/Municipality Pr
8. WEIGHT (kg) 56kg ZIP CODE 6127
9. BLOOD TYPE O+
18. PERMANENT ADDRESS SITIO
House/Block/Lot No. S
14. TIN NO. 735 529 722 20. MOBILE NO. 09569170978
15. AGENCY EMPLOYEE NO. NONE 21. E-MAIL ADDRESS (if any) darwin11080993@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
OCCUPATION N/A
SURNAME BUTCHE
NONE
TRADE
BACHELOR OF SCIENCE IN INFORMATION
COURSE
COLLEGE CENTRAL PHILIPPINES STATE UNIVERSITY
TECHNOLOGY
2014 2018 GRADUATED
Dual Citizenship
by naturalization
SITIO TROZO
Street
BULUANGAN
Barangay
NEGROS OCCIDENTAL
Province
6127
SITIO TROZO
Street
BULUANGAN
Barangay
NEGROS OCCIDENTAL
Province
NONE
09569170978
darwin11080993@gmail.com
N/A
(Continue on separate sheet if necessary)
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
2005 NONE
2009 NONE
CUM
2018
LAUDE
Presidential Decree No. 907 CUMLAUDE JULY 31, 2018 CSC RO VI, ILOILO CITY
NUMBER Date of
Validity
10010618117 APRIL
9 13,2018
STATUS OF
APPOINTMENT
(Y/
N)
JOB ORDER YES
CONTRACTUAL YES
CONTRACTUAL YES
CONTRACTUAL NO
ue on separate sheet if necessary)
NONE
PROGRAMMING
NONE
(PHP,HTML,CSS,JAVASCRIPT)
COMPUTER TROUBLESHOOT
COMPUTER NETWORKING
ENCODING
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
NONE
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? ________________________________
Finished contract
________________________________
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.