CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15308446

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 BORAC
FIRST NAME JOY PAISSA
MIDDLE NAME GALES 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS Brgy.Hinolaso, DOLORES, EASTERN SAMAR

4. DATE OF BIRTH (mm/dd/yyyy) 11 / 01 / 1986
5. PLACE OF BIRTH Brgy.Hinolaso, Dolores E.Samar
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 6817
Married Separated
17. TELEPHONE NO. 09494536801
Annuled Others, specify
_________ 18. PERMANENT ADDRESS Brgy.Hinolaso, Dolores Eastern Samar, DOLORES,
EASTERN SAMAR
8. CITIZENDSHIP FILIPINO
9. HEIGHT (m) 4"9
10. WEIGHT (kg) 53 kgs ZIP CODE 6817
11. BLOOD TYPE O+ 19. TELEPHONE NO.

12. GSIS ID NO. 1529265 20. EMAIL ADDRESS (if any) borac_joypaissa@yahoo.com
13. PAGIBIG ID NO. 12-119872789-6 21. CELLPHONE NO. (if any) 09494536801
14. PHILHEALTH NO. 13-025443153-3 22. AGENCY EMPLOYEE NO.

15. SSS NO. 34-0750435-5 23. TIN 457-013-344

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME BORAC

FIRST NAME TELESPORO

MIDDLE NAME PALCE

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME GALES

FIRST NAME SYLVIA

MIDDLE NAME CABANGANGAN

III. EDUCATIONAL BACKGROUND

HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE SCHOLARSHIP/
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS
GRADUATED ACADEMIC HONORS
(Write in full) (Write in full) EARNED
(if graduated) RECEIVED
(if not
graduated) From To

MAYBOCOG ELEMENTARY
ELEMENTARY 1998
SCHOOL

HINOLASO NATIONAL HIGH

SECONDARY 2003 1999-6-5 2003-3-29 With honors
SCHOOL

VOCATIONAL/ TRADE 2017-12-

Mater Divinae Gratiae College Computer Literacy 2018 2018-01-6
COURSE 23
BACHELOR OF
EASTERN SAMAR STATE 2012-06- 2016-04- DEAN'S LIST SY
COLLEGE ELEMENTARY 2016
UNIVERSITY(main campus) 04 06 2014-2016
EDUCATION

GRADUATE STUDIES

BORAC, JOY PAISSA GALES - T15308446 CS FORM 212 (Revised 2005), Page 1 of 3
IV. CIVIL SERVICE ELIGIBILITY
29. LICENSE (if applicable)
DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE

CES ELIGIBLE (CAREER EXECUTIVE SERVICE

79.80 09 / 21 / 2016 Manila 1529265 10/02/2017
ELIGIBILITY)

V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")

06/07/2017 12/08/2018 Teacher Saint Helena School 9700 0-0 No

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

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

N/A

N/A

N/A

N/A

VII. TRAINING PROGRAMS (Start from the most recent training.)

32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

Engaging Young Learners Through Online Education 08 / 23 / 2017 08 / 23 / 2017 24 51Talk NYSE listed company

2017 Retooling of the Untrained Grades 1-5 and grades 7-10 Teachers on
07 / 21 / 2017 07 / 23 / 2017 72
K-12 Curriculum

Career Guidance and Pre-Employment Seminar 03 / 08 / 2016 03 / 09 / 2016 72 PESO, DOLE, TESDA, POEA

EASTERN SAMAR STATE

eastern Samar History, 1596-1898: An Overview 10 / 09 / 2015 10 / 09 / 2015
UNIVERSITY |

VIII. OTHER INFORMATION

33. 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: 35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION
SPECIAL SKILLS / HOBBIES:
(Write in full) (Write in full)

COOKING N/A N/A

COOKING

BORAC, JOY PAISSA GALES - T15308446 CS FORM 212 (Revised 2005), Page 2 of 3
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees): YES NO

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 If YES, give details:
appointed? _____________________________________
_____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where you will be appointed?
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37. a. Have you ever been formally charged? YES NO

If YES, give details:
_____________________________________
_____________________________________

b. Have you ever been guilty of any administrative offense? YES NO

If YES, give details:
_____________________________________
_____________________________________

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
_____________________________________
_____________________________________

39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
_____________________________________
_____________________________________

40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________
_____________________________________

41. 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 differently abled? YES NO
If YES, please specify:_______________________
c. Are you a solo parent? YES NO
If YES, please specify:_______________________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

Dr. Nenita Q. Descalsote SAINT HELENA SCHOOL PERPETUAL 09955454338

VILLAGE TAGUIG CITY
Mary Grace Detecio BLK.7 LOT27 PRK.10 BRGY. SOUTH 09463442863
DAANG HARI TAGUIG CITY
Ma. Villa G. Geniston BRGY. 02 POBLACION , DOLORES
EASTERN SAMAR
09074283761

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

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

BORAC, JOY PAISSA GALES - T15308446 CS FORM 212 (Revised 2005), Page 3 of 3