personal data capsule sheet(2007)
TRANSCRIPT
Form No. PIS-02
PERSONNEL DATA CAPSULE SHEET
BASIC PERSONAL DATA
TIN NAME EXTENSION (e.g. Jr., Sr.)
SURNAME NICK NAME
FIRST NAME
MIDDLE NAME PLACE OF BIRTH
SEX
CIVIL STATUSCITIZENSHIP
HEIGHT (m)
WEIGHT (kg) PHILHEALTH NO.
BLOOD TYPE SSS NO.
RELIGION PERSONAL E-MAIL ADDRESS
GSIS ID NO. OFFICIAL E-MAIL ADDRESS
GSIS POLICY NO. CELLPHONE NO. (if any)
GSIS BUSINESS PARTNER NO. AGENCY EMPLOYEE NO.
PAG-IBIG ID NO. ATMCURRENT ADDRESS MUNICIPALITY/CITY/PROVINCE ZIP CODE TELEPHONE NO.
PROVINCIAL ADDRESS MUNICIPALITY/CITY/PROVINCE ZIP CODE TELEPHONE NO.
SPOUSE'S SURNAMEPLACE OF BIRTH
FIRST NAME
MIDDLE NAME
OCCUPATION
NAME OF OFFICE
OFFICE ADDRESS
FATHER'S SURNAME
FIRST NAME
MIDDLE NAME
PLACE OF BIRTH
DECEASED
MOTHER'S MAIDEN NAME
FIRST NAME
MIDDLE NAME
PLACE OF BIRTH
DECEASED
CURRENT EMPLOYMENT
NAME OF OFFICE/ DEPARTMENT OLD PLANTILLA POSITION TITLE NEW PLANTILLA POSITION TITLE EFFECTIVITY DATE
PRESENT PLACE OF ASSIGNMENT DESIGNATION KEY OFFICIAL LEGAL BASIS OF PAYMENT EFFECTIVITY DATE
STEP INCREMENT AUTHORIZED SALARY ACTUAL SALARY SALARY BASIS LAST PROMOTION (mm/dd/yyyy) WITH GAP IN GOV'T SERVICE
STATUS OF APPOINTMENT CATEGORY OF SERVICE LEVEL OF POSITION NATURE OF WORK EMPLOYEE STATUS PERSONNEL ACTION
DATE OF BIRTH (mm/dd/yyyy)
Congressional District (1st, 2nd..)
Congressional District (1st, 2nd..)
NAME OF CHILD (Write full name and list all)
DATE OF BIRTH (mm/dd/yyyy)
FIRST DAY IN GOV'T SERVICE (mm/dd/yyyy)
Annulled Others, specify ___________
Single Married
Widowed
Separated
Male Female
DAILY MONTHLY
EXECUTIVE LEVEL
DIVISION CHIEF LEVEL
OTHER SUPERVISORY LEVEL
NON-SUPERVISORY LEVEL
KEY POSITION
ADMIN
TECHNICAL
SUPPORT TO TECHNICAL
FIRST LEVEL
SECOND LEVEL
THIRD LEVEL
PERMANENT
TEMPORARY
PRESIDENTIAL APPOINTEE
CASUAL
CONTRACTUAL - PS
ORIGINAL APPOINTMENT
PROMOTION
TRANSFER
SALARY INCREASECHANGE IN APPOINTMENT STATUS
RECLASSIFICATION
REINSTATEMENT
Revised 2010
ACTIVE ORIGINAL STATION
ACTIVE DETAILED
DISMISSED
ACTIVE STUDY/ SCHOLARSHIP LEAVE
RESIGNED
RETIRED
SUSPENDED
READ THIS FIRST !1. PRINT ALL ANSWERS CLEARLY. Typed answers are preferred but not required.2. For multiple choice items, CHECK THE BOX that corresponds to your answer.3. DO NOT WRITE anything on the "CURRENT EMPLOYMENT" portion. These items are for internal use and will be filled up by the Personnel Division.4. USE EXTRA BLANK SHEET OF PAPER if necessary but please follow the corresponding format.
Recent Photo
NOTE TO EMPLOYEE: DO NOT WRITE ANYTHING ON THIS PORTION. THIS SECTION IS TO BE FILLED UP BY THE PERSONNEL OFFICE
(Number, Street, Subdivision)
(Number, Street, Subdivision)
(mm/dd/yyyy)
YES NO
(mm/dd/yyyy)
YESNO
CONTRACTUAL - 29
YES NO
YES NO
PIS-02(Revised 2010), Page 1 of 4
CO-TERMINUS
REINSTATEMENT
RE-EMPLOYMENT
DISMISSED
DECEASED
EDUCATIONAL BACKGROUND
LEVELINCLUSIVE DATES OF ATTENDANCE
From To
ELEMENTARY
SECONDARY
COLLEGE
GRADUATE STUDIES
CIVIL SERVICE ELIGIBILITY
RATING PLACE OF EXAMINATION / CONFERMENT
LICENSE (if applicable)
NUMBERDATE OF RELEASE
WORK EXPERIENCE (Include private employment. Start from your current work)
INCLUSIVE DATES (mm/dd/yyyy)MONTHLY SALARY
From To
PIS-02(Revised 2010), Page 2 of 4
NAME OF SCHOOL
(Write in full)
DEGREE COURSE (Write in full)
YEAR GRADUATED
(if graduated)
HIGHEST GRADE/ LEVEL/ UNITS EARNED
(if not graduated)
SCHOLARSHIP/ ACADEMIC HONORS
RECEIVED
VOCATIONAL /
TRADE COURSE
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE
DATE OF EXAMINATION / CONFERMENT
POSITION TITLE (Write in full)
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full)
SALARY GRADE & STEP INCREMENT (Format "00-
0")
STATUS OF APPOINTMENT
GOV'T SERVICE
(Yes / No)
VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
POSITION / NATURE OF WORK
From To
TRAINING PROGRAMS (Start from the most recent training.)
From To
OTHER INFORMATION
SPECIAL SKILLS / HOBBIES
PIS-02(Revised 2010), Page 3 of 4
NAME & ADDRESS OF ORGANIZATION (Write in full)
INCLUSIVE DATES
(mm/dd/yyyy) NUMBER OF HOURS
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full)
INCLUSIVE DATES OF ATTENDANCE
(mm/dd/yyyy) NUMBER OF HOURS
CONDUCTED/ SPONSORED BY (Write in full)
NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write
in full)
Are you related by consanguinity or affinity to any of the following :
a.
b.
a. Have you ever been formally charged?
b. Have you ever been guilty of any administrative offense?
Have you ever been a candidate in a national or local election (except Barangay election)?
a. Are you a member of any indigenous group?If YES, please specify: ____________________
b. Are you differently abled?If YES, please specify: ____________________
c. Are you a solo parent?If YES, please specify: ____________________
REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME ADDRESS TEL. NO.
PHOTO
COMMUNITY TAX CERTIFICATE NO.
ISSUED AT SIGNATURE (Sign inside the box)
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK
PIS-02(Revised 2010), Page 4 of 4
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?
If YES, give details: _____________________________________ _____________________________________ _____________________________________
Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed? If YES, give details:
_____________________________________ _____________________________________ _____________________________________
If YES, give details: ________________________________ ________________________________
If YES, give details: ________________________________ ________________________________
Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal? If YES, give details:
________________________________ ________________________________
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?
If YES, give details: ________________________________ ________________________________
If YES, give details: ________________________________ ________________________________
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:
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.
ID picture taken within the last 6 months3.5 cm. X 4.5 cm(passport size)
Computer generated or xerox copy of picture
is not acceptable
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO