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Personal Data Sheet
OWWA form for personal data sheet
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes
with "
No.
" and use separate sheet if necessary.
I. PERSONAL INFORMATION
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FIRST NAME
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MIDDLE NAME
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| 3. NAME EXTENSION (e.g. Jr., Sr.)|
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2. SURNAME
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4. DATE OF BIRTH (mm/dd/yyyy)
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16. RESIDENTIAL ADDRESS
5. PLACE OF BIRTH
Male
6. SEX
7. CIVIL STATUS
Single
Female
Widowed
ZIP CODE
Married
Separated
Annulled
Others, specify ___________ 18. PERMANENT ADDRESS
17. TELEPHONE NO.
8. CITIZENSHIP
9. HEIGHT (m)
ZIP CODE
10. WEIGHT (kg)
11. BLOOD TYPE
19. TELEPHONE NO.
12. GSIS ID NO.
20. E-MAIL ADDRESS (if any)
13. PAG-IBIG ID NO.
21. CELLPHONE NO. (if any)
14. PHILHEALTH NO.
22. AGENCY EMPLOYEE NO.
15. SSS NO.
23. TIN
II. FAMILY BACKGROUND
25. NAME OF CHILD (Write full name and list all)
24. SPOUSE'S SURNAME
DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME
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MIDDLE NAME
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OCCUPATION
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EMPLOYER/BUS. NAME
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BUSINESS ADDRESS
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TELEPHONE NO.
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FIRST NAME
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MIDDLE NAME
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SURNAME
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FIRST NAME
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(Continue on separate sheet if necessary)
26. FATHER'S SURNAME
27. MOTHER'S MAIDEN NAME
(Continue on separate sheet if necessary)
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
28.
LEVEL
NAME OF SCHOOL
(Write in full)
DEGREE COURSE
(Write in full)
YEAR
GRADUATED
(if graduated)
HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)
INCLUSIVE DATES OF
ATTENDANCE
From
To
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SSC FORM,Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29.
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
UNDER SPECIAL LAWS/ CES/ CSEE
RATING
DATE OF
EXAMINATION /
CONFERMENT
LICENSE (if applicable)
PLACE OF EXAMINATION / CONFERMENT
NUMBER
DATE OF
RELEASE
STATUS OF
APPOINTMENT
GOV'T
SERVICE
(Yes / No)
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work)
INCLUSIVE DATES
(mm/dd/yyyy)
30.
From
POSITION TITLE
(Write in full)
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full)
To
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SALARY GRADE
& STEP
INCREMENT
(Format "00-0")
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MONTHLY
SALARY
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(Continue on separate sheet if necessary)
OWWA SSC FORM , Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
31.
INCLUSIVE DATES
(mm/dd/yyyy)
NAME & ADDRESS OF ORGANIZATION
(Write in full)
From
NUMBER OF
HOURS
POSITION / NATURE OF WORK
NUMBER OF
HOURS
CONDUCTED/ SPONSORED BY
(Write in full)
To
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(Continue on separate sheet if necessary)
VII. TRAINING PROGRAMS (Start from the most recent training.)
32.
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES
(Write in full)
INCLUSIVE DATES OF ATTENDANCE
(mm/dd/yyyy)
From
To
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(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
33.
SPECIAL SKILLS / HOBBIES:
34.
NON-ACADEMIC DISTINCTIONS / RECOGNITION:
(Write in full)
35.
MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
(Continue on separate sheet if necessary)
OWWA SSC FORM , Page 3 of 4
36.
Are you related by consanguinity or affinity to any of the following :
a.
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?
YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________
b.
Within the fourth degree (for Local Government Employees):
appointing authority or recommending authority where you will be appointed?
YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________
37
a. Have you ever been formally charged?
YES
NO
If YES, give details:
________________________________
________________________________
YES
NO
If YES, give details:
________________________________
________________________________
b. Have you ever been guilty of any administrative offense?
38.
Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
39.
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?
40.
Have you ever been a candidate in a national or local election (except Barangay election)?
YES
NO
If YES, give details:
________________________________
________________________________
YES
NO
If YES, give details:
________________________________
________________________________
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?
b.
Are you differently abled?
c.
Are you a solo parent?
YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME
ADDRESS
TEL. NO.
ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)
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 OWWA Screening and Selection Committee / authorized representative to verify / validate the
contents stated herein.
Computer generated
or xerox copy of picture
is not acceptable
PHOTO
GOVERNMENT ISSUED I.D. No.
SIGNATURE (Sign inside the box)
ISSUED AT
/
/
ISSUED ON (mm/dd/yyyy)
DATE ACCOMPLISHED
RIGHT THUMBMARK
OWWA SSC Form, Page 4 of 4
