CSC 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)

PERSONAL INFORMATION

2.  SURNAME

FIRST NAME

MIDDLE NAME
TRIESTE

JUVI

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

4.  DATE OF BIRTH (mm/dd/yyyy)
10/01/1976
16.  RESIDENTIAL ADDRESS

ZIP CODE
19 OSMEÑA AVENUE, TIGAYON, KALIBO, AKLAN

5.  PLACE OF BIRTH
NUMANCIA, AKLAN

6.  SEX
[    ] Male    [ / ] Female

7.  CIVIL STATUS
[    ] Single          [    ] Widowed

[  / ] Married        [    ] Separated

[    ] Annulled       [    ] Others, specify____
5600

17.  TELEPHONE NO.
(036) 268-3940

18.  PERMANENT ADDRESS

ZIP CODE
LAGUINBANUA EAST, NUMANCIA, AKLAN

8.  CITIZENSHIP
FILIPINO

9.  HEIGHT (m)
1.55 m

10.  WEIGHT (kg)
45
5604

11.  BLOOD TYPE
“A”
19.  TELEPHONE NO.
(036) 268-9789

12.  GSIS ID NO.
76100101277
20.  E-MAIL ADDRESS (if any)
[email protected]

13.  PAG-IBIG ID NO.
1580-0106-2727
21.  CELLPHONE NO. (if any)
0998-5345899

14.  PHILHEALTH NO.
11-00009464-27
22.  AGENCY EMPLOYEE NO.
20131086

15.  SSS NO.
N/A
23.  TIN
193-154-159

II.  FAMILY BACKGROUND

24.  SPOUSE’S SURNAME

FISRT NAME

MIDDLE NAME
TRIESTE
25.  NAME OF CHILD (Write full name and list all)
DATE OF BIRTH (mm/dd/yyyy)

GENE GERALD III
JEWEL M. TIMTIMAN
09/28/2003

CO
GRAISON CLARK T. TRIESTE
01/17/2007

OCCUPATION
GOVERNMENT EMPLOYEE
KEVIN GEORGE T. TRIESTE
10/26/2010

EMPLOYER/BUS. NAME
PROVINCIAL GOVERNMENT OF AKLAN

/       /

BUSINESS ADDRESS
CAPITOL SITE, KALIBO, AKLAN

/       /

TELEPHONE NO.
268-8759

/       /

(Continue on separate sheet if necessary)

/       /

26.  FATHER’S SURNAME

FIRST NAME

MIDDLE NAME
TIMTIMAN

/      /

MARIO

/       /

ABELLO

/       /

27.  MOTHER’S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME

/       /

MAKINIKA

/       /

DOLORES

/       /

CORDOVA

/       /

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
SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

From
To

ELEMENTARY
LAGUINBANUA ELEMENTARY SCHOOL

1989

1983
1989
VALEDICTORIAN

SECONDARY
AKLAN COLLEGE

1993

1989
1993

VOCATIONAL/ TRADE SCHOOL
N/A

COLLEGE
LA CONSOLACION COLLEGE
BS COMPUTER SCIENCE
1997

1993
1997

GRADUATE STUDIES
AKLAN STATE UNIVERSITY-AKLAN POLICE PROVINCIAL OFFICE CONSORTIUM
MASTERAL IN PUBLIC ADMINSTRATION

9 UNITS
2006
2006

(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
CAREER SERVICE SUB-PROFESSIONAL
84.23%
JULY 22, 2007
KALIBO PILOT ELEMENTARY SCHOOL

CIVIL SERVICE COMMISSION / CAREER SERVICE PROFESSIONAL
80.65%
OCTOBER 23, 2016
KALIBO ELEMETARY SCHOOL
N/A
10/23/2016

V.  WORK EXPERIENCE (Include private employment.  Start from your current work)

30.  INCLUSIVE DATES

(mm/dd/yy)
POSITION TITLE             (Write in Full)
DEPARTMENT/AGENCY/OFFICE/ COMPANY                                    (Write in Full)
MONTHLY SALARY
SALARY GRADE & STEP INCREMENT (Format “00-0”)
STATUS OF APPOINTMENT
GOV’T SERVICE (Yes/No)
From
To
06/01/2015
PRESENT
PROJECT DEVELOPMENT ASSISTANT
OFFICE OF THE PROVINCIAL AGRICULTURIST
16,743.00
SG-8
PERMANENT
YES
07/01/2011
05/31/2015
PROJECT DEVELOPMENT ASSISTANT
PROVINCIAL COOPERATIVE OFFICE
13,141.00
SG-8
PERMANENT
YES
02/01/2007
06/30/20011
ADMINSTRATIVE ASSISTANT II
PROVINCIAL GOVERNOR’S OFFICE
11,054.00
SG-8
CO-TERMINOUS
YES
07/01/2005
01/31/2007
ADMINSTRATIVE AIDE VI
PROVINCIAL GOVERNOR’S OFFICE
7,226.00
SG-6
CO-TERMINOUS
YES
10/16/2004
06/30/2005
JOB ORDER
PROVINCIAL GOVERNOR’S OFFICE
5,000.00

CONTRACTUAL
YES
02/16/2002
05/30/2004
MANAGING DIRECTOR
JMT PRODUCTIONS
15,000.00

NO
05/02/2000
01/30/2002
OPERATIONS MANAGER
EVENTSCAPE MANILA PRODUCTION
10,000.00

NO
10/30/1998
01/30/2000
OPERATIONS MANAGER
EXILE SOUNDS & LIGHTS
10,000.00

NO
12/02/1997
10/15/1998
MARKETING CLERK
ARGEE TV SERVICES
6,000.00

NO
07/01/1997
09/30/1997
CUSTOMER SERVICE
BAYANTEL
5,000.00

NO

(Continue on separate sheet, if necessary)
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
From
To
PROVINCIAL GOVERNMENT EMPLOYEES DEVELOPMENT COOPERATIVE
07/01/2011
PRESENT

SECRETARY

(Continue on separate sheet, if necessary)
VII.  TRAINING PROGRAMS (Start from the most recent training)

32.  TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES

(Write in Full)
INCLUSIVE DATES OF ATTENDACE

(Write in Full)
NUMBER OF HOURS
CONDUCTED/SPONSORED BY

(Write in Full)
From
To
4-H REGIONAL YOUTH CAMP 2019
04/15/2019
04/17/2019
24
AGRICULTURAL TRAINING INSTITUTE-RTC VI
FORUM ON WOMEN WITH DISABILITY
03/25/2019
03/25/2019
8
DEPARTMENT OF SOCIAL WELFARE & DEVELOPMENT – REGION VI
TRAINING ON PROJECT PROPOSAL PREPARATION USING HARMONIZED GENDER AND DEVELOPMENT GUIDELINES TOOLS
03/08/2019
03/08/2019
8
PROVINCIAL PLANNING & DEVELOPMENT OFFICE-AKLAN
4-H REGIONAL ASSESSMENT, CONSULTATTIVE & PLANNING WORKSHOP
03/05/2019
03/06/2019
16
AGRICULTURAL TRAINING INSTITUTE-RTC VI
TRAINING-WORKSHOP ON GENDER AND DEVELOPMENT PLANNING & BUDGETING FY 2020
02/20/2019
02/22/2019
24
PROVINCIAL PLANNING & DEVELOPMENT OFFICE-AKLAN
CLIMATE CHANGE FORUM 2018
12/20/2018
12/20/2018
8
AGRICULTURAL TRAINING INSTITUTE-RTC VI
KAPATID AGRI MENTOR ME PROGRAM BUSINESS COACHING AND MENTORING
11/26/2019
11/30/2018
40
AGRICULTURAL TRAINING INSTITUTE-RTC VI
COMMUNITY TOUR GUIDING SEMINAR WORKSHOP
11/17/2018
11/22/2018
48
DEPARTMENT OF TOURISM-REGION 6
AGRICULTURAL EXTENSION WORKERS CONGRESS 2018
10/29/2018
10/31/2018
24
DEPARTMENT OF AGRICULTURE-RFO 6
WESTERN VISAYAS REGIONAL ORGANIC AGRICULTURE CONGRESS 2018
09/13/2018
09/14/2018
16
DEPARTMENT OF AGRICULTURE-RFO 6
TRAINING OF TRAINERS ON HYBRID RICE TECHNOLOGY
05/07/2018
05/11/2018
40
DEPARTMENT OF AGRICULTURE-RFO 6
4-H REGIONAL SUMMER YOUTH CAMP 2018
04/17/2018
04/20/2018
32
AGRICULTURAL TRAINING INSTITUTE-RTC-VI
TRAINING ON ORGANIC VEGETABLE PRODUCTION
03/24/2018
03/24/2018
8
AGRICULTURAL TRAINING INSTITUTE-RTC-VI
SEMINAR ON VALUES ORIENTATION FOR OPA EMPLOYEES
03/09/2018
03/09/2018
8
AGRICULTURAL TRAINING INSTITUTE-RTC-VI
REGIONAL CONSULTATIVE PLANNING WORKSHOP FOR RURAL BASED ORGANIZATIONS (RBOs)
02/13/2018
02/14/2018
16
AGRICULTURAL TRAINING INSTITUTE-RTC-VI
REGIONAL CONSULTATIVE, ASSESSMENT & PLANNING WORKSHOP FOR 4-H OFFICERS & COORDINATORS
11/12/2017
11/13/2017
16
AGRICULTURAL TRAINING INSTITUTE-RTC-VI
PAG-ASA YOUTH ASSOCIATION OF THE PHILIPPINES-AKLAN PROVINCIAL CONGRESS
11/02/2017
11/04/2017
24
PROVINCIAL SOCIAL WELFARE DEVELOPMENT OFFICE
TRAINING AND HANDS-ON DEMO ON ROOT CROPS  PROCESSINGFOR RURAL BASED ORGANIZATIONS
09/15/2017
09/15/2017
8
OFFICE OF THE PROVINCIAL AGRICULTURIST
PROJECT DEVELOPMENT TRAINING FOR TECHNICAL STAFF OF PROVINCIAL GOVERNMENT OF AKLAN
08/29/2017
08/31/2017
24
NATIONAL ECONOMIC & DEVELOPMENT AUTHORITY-REGION 6
WESTERN VISAYAS  AGRICULTURAL EXTENSION WORKERS CONGRESS 2017
08/15/2017
08/19/2017
40
DEPARTMENT OF AGRICULTURE-RFO 6
TRAINING AND HANDS-ON DEMO ON HERBAL TEA PROCESSING
06/08/2017
06/08/2017
8
OFFICE OF THE PROVINCIAL AGRICULTURIST
TRAINING AND HANDS-ON DEMO ON MUSHROOM PRODUCTION
06/01/2017
06/01/2017
8
OFFICE OF THE PROVINCIAL AGRICULTURIST
FARM YOUTH (4-H) NATIONAL COVENTION
05/23/2017
05/26/2017
32
AGRICULTURAL TRAINING INSTITUTE-
INVESTMENT FORUM ON CASSAVA AND BANANA PRODUCTION
04/24/2017
04/24/2017
8
DEPARTMENT OF AGRICULTURE-RFO 6
4-H SUMMER YOUTH CAMP 2017
04/18/2017
04/20/2017
24
AGRICULTURAL TRAINING INSTITUTE-RTC-VI
TRAINING-WORKSHOP ON CONCEPTUALIZATION & PROJECT PROPOSAL PREPARATION FOR AGRICULTURAL & FISHERY COUNCILS
03/27/2017
03/28/2017
16
DEPARTMENT OF AGRICULTURE-RFO VI
REGIONAL CONSULTATIVE WORKSHOP FOR RURAL BASED ORGANIZATIONS PLANS 2017
02/27/2017
02/28/2017
16
AGRICULTURAL TRAINING INSTITUTE-RTC VI
WORKSHOP FOR THE DEVELOPMENT OF MONITORING & EVALUATION MECHANISM FOR AGRI-FISHERY STRATEGIC PLAN
01/09/2017
01/09/2017
08
PROVINCIAL GOVERNMENT OF AKLAN
FACILITATION SKILLS TRAINING FOR AGRICULTURAL & FISHERY COUNCIL
JUNE 21, 2016
JUNE 23, 2016
24
PHILIPPINE COUNCIL FOR AGRICULTURE AND FISHERY-MANILA
CONSULTATION WORKSHOP FOR AFC COORDINATORS
MARCH 1, 2016
MARCH 3, 2016
24
REGIONAL AGRICULTURAL & FISHERY COUNCIL-ILOILO CITY
REGIONAL CONSULTATION & ASSESSMENT PLANNING WORKSHOP FOR 4-H OFFICERS & COORDINATORS
MARCH 18, 2016
MARCH 19, 2016
16
AGRICULTURAL TRAINING INSTITUTE-RTC VI
REGIONAL PLANNING WORKSHOP FOR RURAL BASED ORGANIZATIONS
JANUARY 14, 2016
JANUARY 15, 2016
16
AGRICULTURAL TRAINING INSTITUTE-RTC VI
REGIONAL CONSULTATIVE,  ASSESSMENT &  PLANNING WORKSHOP FOR 4-H OFFICERS & COORDINATORS
NOV. 12, 2015
NOV. 13, 2015
16
AGRICULTURAL TRAINING INSTITUTE-RTC VI
TRAINING COURSE ON ORGANIZATIONAL PROBLEM ANALYSIS FOR 4-H COORDINATORS
OCT. 28, 2015
OCT. 31, 2015
24
AGRICULTURAL TRAINING INSTITUTE-RTC VI
OREINTATION WORKSHOP FOR AFC MONITORING TEAM
AUG. 5, 2015
AUG. 6, 2015
16
PHILIPPINE COUNCIL FOR AGRICULTURE AND FISHERY-MANILA

(Continue on separate sheet, if necessary)
VIII.  OTHER INFORMATION
33.             SPECIAL SKILLS/HOBBIES
34.  NON-ACADEMIC DISTINCTIONS/RECOGNITION

(Write in Full)
35.  MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in Full)
SINGING                               BOOKKEEPING
N/A
PROVINCIAL GOVERNMENT EMPLOYEES DEVELOPMENT COOPERATIVE (PGEDECO)
DANCING                             DRAWING

FACILITATION                     COOKING

(Continue on separate sheet, if necessary)
CS FORM 212 (Revised 2005) Page 3 of 4

36.  Are you related by consanguinity 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:

________________________________________________________________________
b.   Within the fourth civil degree (for Local Government Employees):

Appointing authority or recommending authority where you will be appointed?

[   ]  YES         [ / ] NO

If YES, give details:

____________________________________________________________________________________________________________

37.  a.  Have you ever been formally charged?

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

If YES, give details:

________________________________________________________________________

[   ] YES         [ / ] NO

If YES, give details:

38.  Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?
[   ] YES         [ / ] NO

If YES, give details:

________________________________________________________________________
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         [ / ] NO

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 Parent Welfare Act of 2000 (RA 8972), please answer the following items:

a.   Are you a member of any indigenous group?

b.   Are you differently abled?

c.   Are you a solo parent?
 

[   ] YES          [ / ] NO

If YES, please specify: _____________

[ / ] YES          [   ] NO

If YES, please specify: _____POLIO___

[   ] YES          [ / ] NO

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

ID picture taken within the

last 6 months

3.5 cm. X 4.5 cm

(passport size)

Computer generated

or Xerox copy of picture

is not applicable.

PHOTO
ENGR. CARLITO S. MARQUEZ
CONGRESSIONAL DISTRICT OFFICE, KALIBO, AKLAN
(036) 268-4118
DR. JULIUS R. GONZALES
PROVINCIAL GOVERNMENT OF AKLAN
(036) 268-4470
ATTY. REYNALDO M. QUIMPO
PROVINCIAL GOVERNMENT OF AKLAN
(036) 268-5572
43.  I DECLARE UNDER OATH THAT THIS personal Data Sheet has been accomplished by me, and is true and correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.

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

00996234
COMMUNITY TAX CERTIFICATE NO.
KALIBO, AKLAN
ISSUED AT

OCTOBER 12, 2016

DATE ACCOMPLISHED

02/04/16
ISSUED ON (mm/dd/yyyy)
RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 0f 4