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Region : Region I

Division :

School ID:

Name of Office / School :

Total no. of Filled-up Plantilla Positions:

Total no. of Personnel Re-assigned to:

Total no. of Personnel reassigned from:0

Total no. of contractual employees:0

Total no. of casual employees:0

Total no. of locally funded employees:

To be EncodedManually

Summary fromI.Personal

Total no. of Authorized Positions (perPSI-PP!:

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PARENTHETICAL TITLE

NA

LAST NAME FIRST NAME

UNIQUE ITEMNUMBER

POSITION TITLE PERPLANTILLA

SALARYGRADE

SALARYSTEP

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OF PERSONNEL

SEX TIN

MIDDLE NAME NAME EXTENSION

DATE OF BIRTH (MM-DD-YYYY)

DATE OF ORIGINALAPPOINTMENT (ASNATIONAL) (MM-DD-

YYYY)

DATE OF LASTPROMOTION /

APPOINTMENT (MM-DD-YYYY)

EMPLOYSTAT

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FUNDING CIVIL STATUS SSS NPLACE OF BIRTH

(TOWN, PROVINCEOR CITY)

H!"#$(%)

W!"#$(&")

B'ooT*

GSIS BPNo.

PAG-IBIGNo. (I+ $

+o$0!)

PHILHEALTH No.(I+ $ +o$0!)

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R1!+$!2' A11 (I+ $ +o$ 0!)

R"!o+ Po3!+ / D!1$!$ / C!$ C!$/ M+!!*2'!$ B22+"2 T'*#o+ NoA11 (Ho1 No, S$$ N2%,

V!''2"/S)

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P%2++$ A11 (R0!)

R"!o+ Po3!+ / D!1$!$ / C!$ C!$ / M+!!*2'!$ B22+"2 T'*#o+ NoA11 (Ho1 No, S$$ N2%,

V!''2"/S)

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C''*#o+ No. (!4 2+)

R211!"+ Fo%E%2!' A11

(*42'5*."o3.*#) R211!"+ Fo%6

R"!o+/ D!3!1!o+/ D!1$!$R211!"+ Fo%6 S#oo'

IDL2+"2"1/D!2'$

S*o&+

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"A#$

RELATIONSHIPLASTNAME

FIRSTNAME(%AST "A#$& FIRST "A#$ #I''%$ "A#$ "A#$

$T$"SI"!

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FOR CHIL ONL! FOR SPO"SE ONL!

OCC"PATION

MILENAME ATE OF #IRTH $MM%

%!!!!&EMPLO!ER'#"S. NAME

#"SINESSARESS

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TELEPHONENO.

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NAME

LEVEL(LAST NAME, FIRST NAME MIDDLE NAME

NAME EXTENSION)

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E"CATIONAL #AC()RO"N

Name of Sc*ool

I")%*SI+$ ,$AR

From To,ear

raduatedighest rade/%e0el/*nits$arned (if not graduated!

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Course Ma+or M,norHonors

Rece,-ed

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"A#$

(%AST "A#$& FIRST "A#$ #I''%$ "A#$ "A#$$T$"SI"!

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$%II1I%IT, RATI"'AT$ F $A#/

)"F$R#$"T (##-''-,,,,!

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%I)$"S$

"*#1$R

P%A)$ F $A# /)"F$R#$"T ISS*$ 'AT$ (##-''-

,,,,!

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NAME INCL"SIE ATE $MM%%!!!!&

FROM TO(LAST NAME, FIRST NAME MIDDLE NAME NAMEEXTENSION)

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OR( E/PERIENCES

POSITIONTITLE

EPARTMENT 'A)ENC! ' OFFICE

MONTHL!SALAR!

SALAR!RAN)E')RAE

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STEPINCREMENT

STAT"S OFAPPOINTMENT

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Enter trainings within the last fve years star

NAME

(LAST NAME, FIRST NAME MIDDLE NAME NAMEEXTENSION)

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ing with the most recent

TITLE OF SEMINAR AREA OF TRAININ)

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INCL"SIE ATES $MM%%!!!!&

FROM TO

NO. OFHO"RS

CON"CTE#!

PLACE OFTRAININ)