CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15267320

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 EGA
FIRST NAME RUEL
MIDDLE NAME BARILLO 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS PAGKAKAISA, KABACAN, NORTH COTABATO

4. DATE OF BIRTH (mm/dd/yyyy) 12 / 29 / 1980
5. PLACE OF BIRTH Bannawag,Kabacan, Cotabato
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 9407
Married Separated
17. TELEPHONE NO. 09101012557
Annuled Others, specify
_________ 18. PERMANENT ADDRESS PAGKAKAISA, KABACAN, NORTH COTABATO

8. CITIZENDSHIP Filipino
9. HEIGHT (m) 5
10. WEIGHT (kg) 54 ZIP CODE 9407
11. BLOOD TYPE O+ 19. TELEPHONE NO. 09101012557
12. GSIS ID NO. 20. EMAIL ADDRESS (if any) eddieboydapeng@gmail.com
13. PAGIBIG ID NO. 21. CELLPHONE NO. (if any) 09101012557
14. PHILHEALTH NO. 17-201034862-0 22. AGENCY EMPLOYEE NO.

15. SSS NO. 23. TIN 463-974248

II. FAMILY BACKGROUND

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

FIRST NAME Yollanda Audreah Jhoy G. Ega 01 / 10 / 2010

MIDDLE NAME Garcia

OCCUPATION Housewife

EMPLOYER/BUS. NAME Space for rent

BUSINESS ADDRESS Kabacan, Cotabato

TELEPHONE NO. 09468455198

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME Ega

FIRST NAME Marquez

MIDDLE NAME Atimama

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Ega

FIRST NAME Minerva

MIDDLE NAME Barillo

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

Bannawag, Elementary,
ELEMENTARY 1994 1988 1994 awardee
School

SECONDARY Bannawag, High, School 1998 1994 1998 Salutatorian

VOCATIONAL/ TRADE
God's Bible College Basic Bible Course 2003 2002 2003
COURSE

Bachelor of Science
COLLEGE St. Luke Institute's 2003 1999 2003 awardee
in Commerce

Cotabato Foundation College Professional

GRADUATE STUDIES 2017 32 2016 2017
of Science And Technology Education Units

IV. CIVIL SERVICE ELIGIBILITY

EGA, RUEL BARILLO - T15267320 CS FORM 212 (Revised 2005), Page 1 of 4

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")

Magic Mall Branch,Norther Luzon

06/01/2005 05/31/2009 Branch Manager 14,000 0-0 Permanent No
Telecom Center

06/01/2004 05/31/2005 Head Audito Northern Luzon Telecom Center 8,500 0-0 Permanent No

06/10/2003 05/31/2004 Assistant Accounting Clerk Northern Luzon Telecom Center 4,000 0-0 Contractual 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

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

Practice Teaching 06 / 01 / 2017 11 / 03 / 2017 Aringay National High School

Government Service Insurance

Government Internship Program (Job Training) 04 / 24 / 2001 05 / 31 / 2001 System, Davao Branch Office,
Matina Davao City

VIII. OTHER INFORMATION

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

Artist/Stage and Event Decorator Guest Speaker of BIYO Fellowship

Judge for Mr. & Ms Ambassador and Ambassadress

Board of Judges during Miss Gay Valentines Universe

Judge for Asian Next Top Model Cycle 2

Member for Outreach Program

Parent-Teachers Association's(PTA) President for two consecutive

years.

Judge for Mr. & Ms. Intramurals

Sponsor for Mutya ng Kabacan

Adjudicator during Miss Gay Festival

Sponsor during Rang-ay Festival 2018

EGA, RUEL BARILLO - T15267320 CS FORM 212 (Revised 2005), Page 2 of 4

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.

Akmad K. Kadingilan Poblacion Kabacan, Cotabato 09983485998

Maano A. Kadingilan Poblacion Kabacan, Cotabato 09185240555

Eddieboy Dapeng

Akmad K. Kadingilan
Malanduage, Kabacan, Cotabato

Poblacion Kabacan, Cotabato

09462971834

09983485998 X
Maano A. Kadingilan Poblacion Kabacan, Cotabato 09185240555

Eddieboy Dapeng Malanduage, Kabacan, Cotabato 09462971834

PHOTO
Akmad K. Kadingilan Poblacion Kabacan, Cotabato 09983485998

Maano A. Kadingilan Poblacion Kabacan, Cotabato 09185240555

Eddieboy Dapeng Malanduage, Kabacan, Cotabato 09462971834

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.

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

EGA, RUEL BARILLO - T15267320 CS FORM 212 (Revised 2005), Page 3 of 4

 09311399

COMMUNITY TAX CERTIFICATE NO.

Bannawag, Kabacan, Cotabato

ISSUED AT SIGNATURE (Sign inside the box)

2018-01-05

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

EGA, RUEL BARILLO - T15267320 CS FORM 212 (Revised 2005), Page 4 of 4