NUMBER OF HOURS From To (Continue on separate sheet if necessary) VIII. OTHER INFORMATION 31. SPECIAL SKILLS and HOBBIES 32. 33. 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) NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full)
(Continue on separate sheet if necessary) SIGNATURE DATE CS FORM 212 (Revised 2017), Page 3 of 4
34.Are you related by consanguinity or affinity to the appointing or recommending authority, or to thechief 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. If YES, please specify ID No: 41.NAMEADDRESSTEL. NO. PHOTO Government Issued ID: ID/License/Passport No.:
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