CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15309608

1. CS ID
Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. No. (to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME FERARO
FIRST NAME ARISTON JR
MIDDLE NAME RACOSA 3. NAME EXTENSION (e.g. Jr., Sr.) JR.
16. RESIDENTIAL ADDRESS 04 San Pedro St.Pob.Central, SISON, PANGASINAN
4. DATE OF BIRTH (mm/dd/yyyy) 12 / 31 / 1982
5. PLACE OF BIRTH Rosales,Pangasinan
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 2434
Married Separated
17. TELEPHONE NO.
Annuled Others, specify
_________ 18. PERMANENT ADDRESS 04 San Pedro St.Pob.Central, SISON, PANGASINAN

8. CITIZENDSHIP Filipino
9. HEIGHT (m) 172
10. WEIGHT (kg) 56 ZIP CODE 2434
11. BLOOD TYPE O+ 19. TELEPHONE NO.

12. GSIS ID NO. 20. EMAIL ADDRESS (if any) aristonjrferaro@gmail.com

13. PAGIBIG ID NO. 21. CELLPHONE NO. (if any) 09496459477
14. PHILHEALTH NO. 050253494864 22. AGENCY EMPLOYEE NO.

15. SSS NO. 02-3267172-8 23. TIN

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 01 / 01 / 1970

MIDDLE NAME 01 / 01 / 1970

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME Feraro

FIRST NAME Ariston Sr

MIDDLE NAME Quema

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Racosa

FIRST NAME Zenaida

MIDDLE NAME Jimenez

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Sison Central School 1995 1988 1995

Our Lady of Mt. Carmel

SECONDARY 1999 1995 1999
Academy

VOCATIONAL/ TRADE
N/A N/A
COURSE

Bachelor of
COLLEGE City Colleges of Urdaneta 2004 1999 2004
Secondary Education

Masteral of Arts In
GRADUATE STUDIES Urdaneta City University 18 2009 2010
Education

IV. CIVIL SERVICE ELIGIBILITY

FERARO, ARISTON JR RACOSA - T15309608 CS FORM 212 (Revised 2005), Page 1 of 3
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

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")

12/18/2018 12/18/2018 Teacher 4,200 0-0 No

Department of the Interior and

12/18/2018 12/18/2018 Barangay Secretary 4,800 0-0 Yes
local Government

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

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

Student- Teaching Workshop 12 / 18 / 2018 12 / 18 / 2018 16 City College of Urdaneta

Division Conference- Workshop on Preschool/Early Chidhood Education 12 / 18 / 2018 12 / 18 / 2018 8 DAPSMECS

DILG Local Government Unit of

Barangay Newly Elected Officials (BNEO) 12 / 18 / 2018 12 / 18 / 2018 24
Sison Pangasinan

VIII. OTHER INFORMATION

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

Computer Literate N/A N/A

FERARO, ARISTON JR RACOSA - T15309608 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.

Mina Joy Pangasinan Sison Pangasinan 09309065128

Clarita C. Pelon Sison Pangasinan 09265535206

Felimon Gutierrez Sison Pangasinan 09358955617

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

08974529

COMMUNITY TAX CERTIFICATE NO.

Sison Pangasinan

ISSUED AT SIGNATURE (Sign inside the box)

2018-03-22 12 / 18 / 2018

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

FERARO, ARISTON JR RACOSA - T15309608 CS FORM 212 (Revised 2005), Page 3 of 3