NUMBER OF HOURS POSITION / NATURE OF WORK From To NONE (Continue on separate sheet if necessary) VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED (Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions) 30. NUMBER OF HOURS From To STAKEHOLDER'S TRAINING 6/1/2009 6/5/2009 40 HOURS GANAPAN LIVELIHOOD PROGRAM BASIC LIFE SUPPORT TRAINING 9/25/2014 9/25/2014 2 HOURS SEMINAR ON ANTI-VIOLENCE AGAINST WOMEN AND CHILDREN 9/25/2014 9/25/2014 2 HOURS LOCAL GOVERNMENT UNIT OF ROXAS (Continue on separate sheet if necessary) VIII. OTHER INFORMATION 31. SPECIAL SKILLS and HOBBIES 32. 33. FILING NONE NONE RECORDING (Continue on separate sheet if necessary) SIGNATURE DATE CS FORM 212 (Revised 2017), Page 3 of 4 NAME & ADDRESS OF ORGANIZATION (Write in full) INCLUSIVE DATES (mm/dd/yyyy) TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS (Write in full) INCLUSIVE DATES OF ATTENDANCE (mm/dd/yyyy) Type of LD ( Managerial/ Supervisory/ Technical/etc) CONDUCTED/ SPONSORED BY (Write in full) MUNICIPAL DISASTER RISK REDUCTION MANAGEMENT OFFICE NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)
34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the chief of bureau or office or to the person who has immediate supervision over you in the Office, Bureau or Department where you will be apppointed, a. within the third degree? b. within the fourth degree (for Local Government Unit - Career Employees)? 35. a. Have you ever been found guilty of any administrative offense? Date Filed: Status of Case/s: 36. 37. 38. If YES, give details: If YES, give details: 39. Have you acquired the status of an immigrant or permanent resident of another country? If YES, give details (country): 40. a. Are you a member of any indigenous group? If YES, please specify: b. Are you a person with disability? If YES, please specify ID No: c. Are you a solo parent? If YES, please specify ID No: 41. NAME ADDRESS TEL. NO. CAPT. BALANGAO, JIDIDIA BARANGAY I, ROXAS, PALAWAN NONE HON. APGAO, NARDO F. 9309064253 HON. LARROSA, ROCHIE BARANGAY II, ROXAS, PALAWAN NONE 42. PHOTO Government Issued ID: LGU ID-0076-2017 ID/License/Passport No.: Signature (Sign inside the box) Date/Place of Issuance: Date Accomplished Right Thumbmark SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.
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- Fall '19
- ADMINISTRATIVE AIDE II, BANTAY ROXAS