CRT PDS

College for Research and Technology
of Cabanatuan
Burgos Avenue, Cabanatuan City 3100
Tel. 463-2735 463-2697 600-2200 e-mail: [email protected]
HUMAN RESOURCE DEVELOPMENT DEPARTMENT
College for Research & Technology

PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes with “/” and use separate sheet if necessary. CRT EMPLOYEE
NUMBER: 635
EMPLOYEE INFORMATION
Last Name: SALAYSAY First Name: MARK BINGBONG Middle Name: DE GUZMAN
Current Position: FULL TIME INSTRUCTOR Department/Program:
Bank Account Number: 119-3-119-15194-6 TIN Number: 325-731-369
SSS Number: 02-3968026-2 PhilHealth Number: 210253596869
Date Employed: June 2018 Date Renewed: June 2019
Status: o Full-Time o Probationary o Permanent

PERSONAL INFORMATION
Contact Number(s): Sex: o Male o Female

Date of Birth: OCTOBER 16, 1996 Place of Birth: GAPAN CITY
Civil Status: __/__Single ____ Married ___Annulled Nationality: FILIPINO

____Widowed ____Separated
Blood Type: Email Address: Home Address: SAN VICENTE, GAPAN CITY N.E.
[email protected]
Name of Spouse: Occupation:
Contact Number: Address:
CHILDREN’S/ DEPENDENT’S INFORMATION
Children’s/Dependent’s Name Date of Birth
Father’s Name Mother’s Maiden Name

Occupation Occupation
of Cabanatuan
EDUCATIONAL BACKGROUND (Excluding Short Courses)
LEVEL NAME OF SCHOOL DEGREE YEAR HIGHEST SCHOLARSHIP/

COURSE GRADUATED GRADE/LEVEL/ ACADEMIC
UNITS EARNED HONORS
RECEIVED
ELEMENTARY
GAPAN SOUTH CENTRAL 2009
SCHOOL
SECONDARY 2013
JUAN R. LIWAG MEMORIAL
HIGH SCHOOL
VOCATIONAL/
TRADE -
COURSE
COLLEGE BSE- 2018

NUEVA ECIJA UNIVERSITY OF ENGLISH
SCIENCE AND TECHNOLOGY
GRADUATE
STUDIES
(Continue on separate sheet if necessary)
EXAMINATIONS/ASSESSMENT PASSED & CIVIL SERVICE ELIGIBILITY

EXAMINATIONS/COMPETENCY DATE OF PLACE OF LICENSE/NUMBER DATE OF
ASSESSMENTS/CAREER EXAMINATION/CONFERENCE/ASSESSMENT EXAMINATION/CONFERENCE/ASSESSMENT /ASSESSMENT RELEASE
SERVICE/RA 1080/CES/CSEE NUMBER
EVENTS 2017 GAPAN CITY - -

MANAGEMENT NC
III
of Cabanatuan
WORK EXPERIENCE (Starting from recent work and excluding OJT)

COMPANY/SCHOOL/ POSITION/TITLE STATUS OF MONTHLY INCLUSIVE
ORGANIZATION/ESTABLISHMENT/AGENCY APPOINTMENT SALARY DATES
FROM TO
Continue on separate sheet if necessary)

SOCIO-CIVIC INVOLVEMENT (Voluntary Work/ Non-Government/ Association/Organizations)
NAME & ADDRESS OF INCLUSIVE DATES NUMBER OF HOURS POSITION/ NATURE OF

ORGANIZATON WORK
FROM TO
of Cabanatuan
PROFESSIONAL ORGANIZATION (Memberships and Positions in association/organization)
NAME & ADDRESS OF INCLUSIVE DATES DISTINCTIONS/RECOGNITIONS POSITION

ORGANIZATON
FROM TO

TRAINING PROGRAMS (Starting from recent training within five (5) years)
SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES INCLUSIVE DATES NUMBER OF SPONSOR/

FROM TO HOURS ORGANIZER
International
National
Regional
Local/ Institutional
REALIZING LEADERSHIP CAPACITY THROUGH COOPERATIVE SEPT. 19, SEPT. 20, 24 LOCAL
TEAM WORK AND SOLIDARITY 2015 2015 STUDENT
COUNCIL
WEBBING ACCOUNTABILITY ON STUDENT-LEADERS: JUNE 12, JUNE 14, 36 UNIVERSITY
CRAFTING THE FUTURE OF THE ORGANIZATION 2017 2017 STUDENT
GOVERNMENT
THE HEART AND SCIENCE OF TEACHING SEPT. 21, SEPT. 22, 36 COLLEGE OF
2017 2017 EDUCATION
TEACHING AND APPLYING LITERARY THEORY AND SEPT. 16, SEPT. 16,
12 ADAMSON
CRITICISM 2017 2017 UNIVERSITY
PUBLISHED BOOKS & MANUALS/MAGAZINES & JOURNALS EDITED
of Cabanatuan
Books Publisher Date of Publication
Manuals Publisher Date of Publication
Books Edited Publisher Date of Publication
Books Edited Publisher Date of Publication
ARTICLES AND PROJECT/ RESEARCH REPORTS/ PAPER PRESENTED
Published Articles Journal Published Date of Publication
Research Reports Funding Agency Date of Report
Title of Paper Presented Conference/ Seminar Paper was Read Date
THESIS/ CAPSTONE ADVISER/ PANELIST

Workshop/ Training Title Venue Position (Organizer,
Speaker, Date
Facilitator,
Etc.)

AWARDS RECEIVED (Professional, Non-Academic, Socio-Civic)
OTHER INFORMATION
of Cabanatuan
NON-ACADEMIC ORGANIZATION/ESTABLISHMEN/EVENT
DISTINCTIONS/RECOGNITION/ACHIEVEMENTS
(Use additional sheet/s if necessary)
SPECIAL SKILLS/HOBBIES/SPORTS
A. Have you ever been formally charged? □ Yes □ No If yes, give details:
________________________________________
B. Have you ever been guilty of any □ Yes □ No If yes, give details:
administrative offense? ________________________________________
C. Have you ever been convicted of any crime □ Yes □ No If yes, give details:
or violation of any law, degree, ordinance or ________________________________________
regulation by any court or tribune?
D. Have you ever been separated from the □ Yes □ No If yes, give details:
previous employment in any of the
following modes: resignation, retirement,
dropped from the rolls, dismissal,
termination, end of term, finished contract, (Give details of mode of separation & reason)
AWOL or phased out?
E. Have you ever been a candidate in a □ Yes □ No If yes, give details:
national or local election? ________________________________________
F. Are you:
1. A member of any indigenous group? □ Yes □ No If yes, give details: ____________

2. Differently abled? □ Yes □ No If yes, give details: ____________
3. A solo parent? □ Yes □ No If yes, give details: ____________
REFERENCES
NAME COMPANY & ADDRESS TEL. NO.
SHERWIN CONSTANTINO BUSINESSMAN 09178103658

EMMA DELA CRUZ PRINCIPAL 09153772708
of Cabanatuan
I declare under oath that this Personnel Data Sheet has been accomplished by me, and is true, correct, and complete
Statement pursuant to the provisions of pertinent laws, rules & regulations of the Republic of the Philippines.
I authorize the authorized representative to validate the contents stated herein. I trust that this information shall remain
confidential.
SIGNATURE OVER
PRINTED NAME
Human Resource
Development/
Research & Development/
VP Administration &
Finance/ Registrar
Accounting Office
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College for Research and Technology

HUMAN RESOURCE DEVELOPMENT DEPARTMENT

College for Research & Technology

Current Position: FULL TIME INSTRUCTOR Department/Program:

Bank Account Number: 119-3-119-15194-6 TIN Number: 325-731-369

SSS Number: 02-3968026-2 PhilHealth Number: 210253596869

Date Employed: June 2018 Date Renewed: June 2019

Status: o Full-Time o Probationary o Permanent

Contact Number(s): Sex: o Male o Female

Civil Status: __/__Single ____ Married ___Annulled Nationality: FILIPINO

Contact Number: Address:

CHILDREN’S/ DEPENDENT’S INFORMATION

Children’s/Dependent’s Name Date of Birth

Father’s Name Mother’s Maiden Name

EDUCATIONAL BACKGROUND (Excluding Short Courses)

LEVEL NAME OF SCHOOL DEGREE YEAR HIGHEST SCHOLARSHIP/

COLLEGE BSE- 2018

(Continue on separate sheet if necessary)

EXAMINATIONS/ASSESSMENT PASSED & CIVIL SERVICE ELIGIBILITY

EVENTS 2017 GAPAN CITY - -

(Continue on separate sheet if necessary)

WORK EXPERIENCE (Starting from recent work and excluding OJT)

Continue on separate sheet if necessary)

NAME & ADDRESS OF INCLUSIVE DATES NUMBER OF HOURS POSITION/ NATURE OF

(Continue on separate sheet if necessary)

PROFESSIONAL ORGANIZATION (Memberships and Positions in association/organization)

NAME & ADDRESS OF INCLUSIVE DATES DISTINCTIONS/RECOGNITIONS POSITION

(Continue on separate sheet if necessary)

SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES INCLUSIVE DATES NUMBER OF SPONSOR/

Books Publisher Date of Publication

Manuals Publisher Date of Publication

Books Edited Publisher Date of Publication

Books Edited Publisher Date of Publication

ARTICLES AND PROJECT/ RESEARCH REPORTS/ PAPER PRESENTED

Published Articles Journal Published Date of Publication

Research Reports Funding Agency Date of Report

Title of Paper Presented Conference/ Seminar Paper was Read Date

THESIS/ CAPSTONE ADVISER/ PANELIST

(Continue on separate sheet if necessary)

(Use additional sheet/s if necessary)

1. A member of any indigenous group? □ Yes □ No If yes, give details: ____________

NAME COMPANY & ADDRESS TEL. NO.

SHERWIN CONSTANTINO BUSINESSMAN 09178103658

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Civil Status: /Single __ Married _Annulled Nationality: FILIPINO