AREA X - ADMINISTRATION PARAMETER G

AACUP Level 1 Accreditation BEED Implementation I.1. The institution’s Planning and Development Unit plans, monitors and evaluates planned activities/targets.  Organizational Structure of the Planning & Development Unit  Duties & responsibilities of the Planning & Development Officer & Office Staff  PDS of the Planning & Development Officer & Office Staff  Picture of the Planning & Development Office I.2. The planning process is a cooperative and participative endeavour of the administration, the faculty staff and the students.  Sample printed programs for planning activity  Attendance sheet of participants  Minutes of the meeting

 Pictures of the planning activity I.3. The SDP is implemented, monitored, evaluated, reviewed and updated regularly.  Copy of SDP  Accomplishment Report of the planning & development office  Pictures showing the SDP is reviewed & evaluated

AACCUP Level 1 Accreditation BEED I.1 Organizational Structure of the Planning & Development Unit Duties & responsibilities of the Planning & Development Officer & Office Staff PDS of the Planning & Development Officer & Office Staff Picture of the Planning & Development Office







CS Form No. 212 PERSONAL DATA SHEET Revised 2017 WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the person concerned. READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM. 1. CS ID No. (Do not fill up. For CSC use only) Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. I. PERSONAL INFORMATION 2. SURNAME JAVA FIRST NAME ALMAR NAME EXTENSION (JR., SR) MIDDLE NAME JIMENEZ 3. DATE OF BIRTH 05/21/1991 16. CITIZENSHIP Filipino Dual Citizenship (mm/dd/yyyy) by birth by naturalization 4. PLACE OF BIRTH CABATUAN, ILOILO If holder of dual citizenship, Pls. indicate country: 5. SEX please indicate the details. Male Female 6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS Widowed Separated 7. HEIGHT (m) O t her/s : House/Block/Lot No. Street 8. WEIGHT (kg) ACAO 9. BLOOD TYPE 1.6764m Subdivision/Village Barangay 10. GSIS ID NO. CABATUAN ILOILO 11. PAG-IBIG ID NO. 50KG ZIP CODE 5031 Province 12. PHILHEALTH NO. AB+ 18. PERMANENT ADDRESS City/Municipality Street 2004545466 House/Block/Lot No. ACAO Barangay 914205004044 Subdivision/Village ILOILO CABATUAN Province City/Municipality 11-0506186420 ZIP CODE 5031 13. SSS NO. 0728465215 19. TELEPHONE NO. N/A 14. TIN NO. 435-705-676 20. MOBILE NO. 09267586140 15. AGENCY EMPLOYEE NO. 001792 21. E-MAIL ADDRESS (if any) [email protected] II. FAMILY BACKGROUND N/A N/A NAME EXTENSION (JR., SR) 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) ANGEL N/A N/A 22. SPOUSE'S SURNAME N/A FIRST NAME N/A NAME EXTENSION (JR., SR) MIDDLE NAME N/A N/A OCCUPATION N/A EMPLOYER/BUSINESS NAME JAVA BUSINESS ADDRESS TELEPHONE NO. PELONIA 24. FATHER'S SURNAME FIRST NAME JIMENEZ (Continue on separate sheet if necessary) MIDDLE NAME ELSA 25. MOTHER'S MAIDEN NAME SURNAME BORDON FIRST NAME MIDDLE NAME NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE HIGHEST LEVEL/ YEAR SCHOLARSHI P/ (Write in full) (Write in full) UNITS EARNED GRADUATED ACADEM I C III. EDUCATIONAL BACKGROUND (if not graduated) HONORS PRIMARY RECEIVED 26. LEVEL From To ELEMENTARY PARRENO ELEMENTARY SCHOOL 1998 2004 N/A 2004 N/A SECONDARY CABATUAN NATIONAL COMPREHENSIVE HIGH HIGH SCHOOL 2004 2008 N/A 2008 N/A VOCATIONAL / SCHOOL N/A N/A TRADE COURSE N/A 2013 N/A COLLEGE N/A N/A N/A N/A 2017 MAGNA CUM WEST VISAYAS STATE UNIVERSITY 2013 N/A LAUDE GRADUATE STUDIES BACHELOR OF SECONDARY EDUCATION MAJOR 2009 N/A IN SOCIAL SCIENCE SIGNATURE UNIVERSITY OF THE PHILIPPINES VISAYAS MASTER OF EDUCATION IN SOCIAL STUDIES 2014 2017 (Continue on separate sheet if necessary) DATE October 15, 2021 C S FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY 27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL RATING DATE OF EXAMINATION / LICENSE (if applicable) (If Applicable) CONFERMENT LAWS/ CES/ CSEE BARANGAY PLACE OF EXAMINATION / CONFERMENT NUMBER Date of Validity ELIGIBILITY / DRIVER'S LICENSE LICENSURE EXAMINATION FOR TEACHERS 84.00% 09/29/2013 JARO NATIONAL HIGH SCHOOL 06841333 11/22/2013 (Continue on separate sheet if necessary) V. WORK EXPERIENCE (Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. 28. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY SALARY/JOB/ PAY STATUS OF GOV'T SERVICE (mm/dd/yyyy) (Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY GRADE (ifapplicable)& APPOINTMENT (Y/ N) STEP (Format\"00-0\")/ From To INSTRUCTOR 1 WEST VISAYAS STATE UNIVERSITY-HIMAMAYLAN CITY ₱22,938.00 PERMANENT YES INSTRUCTOR 1 CAMPUS IN C R EMEN T PERMANENT YES 01/01/2020 12/31/2020 INSTRUCTOR 1 PERMANENT YES 01/01/2019 12/31/2019 INSTRUCTOR 1 WEST VISAYAS STATE UNIVERSITY-HIMAMAYLAN CITY ₱22,938.00 12-1 CONTRACTUAL YES 08/16/2018 12/31/2018 INSTRUCTOR 1 CAMPUS 12-1 CONTRACTUAL YES 06/01/2018 08/15/2018 INSTRUCTOR 1 12-1 CONTRACTUAL YES 01/01/2018 05/31/2018 INSTRUCTOR 1 WEST VISAYAS STATE UNIVERSITY-HIMAMAYLAN CITY ₱22,149.00 12-1 CONTRACTUAL YES 06/01/2017 12/31/2017 INSTRUCTOR 1 CAMPUS 12-1 CONTRACTUAL YES 01/01/2017 05/31/2017 INSTRUCTOR 1 12-1 CONTRACTUAL YES 06/01/2016 12/31/2016 INSTRUCTOR 1 WEST VISAYAS STATE UNIVERSITY-HIMAMAYLAN CITY ₱22,149.00 12-1 CONTRACTUAL YES 01/01/2016 05/31/2016 INSTRUCTOR 1 CAMPUS 12-1 CONTRACTUAL YES 06/01/2015 12/31/2015 12-1 07/02/2014 05/31/2015 WEST VISAYAS STATE UNIVERSITY-HIMAMAYLAN CITY ₱22,149.00 12-1 CAMPUS 12-1 WEST VISAYAS STATE UNIVERSITY-EXTENSION CAMPUS ₱21,387.00 AT HIMAMAYLAN CITY WEST VISAYAS STATE UNIVERSITY-EXTENSION CAMPUS ₱21,387.00 AT HIMAMAYLAN CITY WEST VISAYAS STATE UNIVERSITY-EXTENSION CAMPUS ₱20,651.00 AT HIMAMAYLAN CITY WEST VISAYAS STATE UNIVERSITY-EXTENSION CAMPUS ₱20,651.00 AT HIMAMAYLAN CITY WEST VISAYAS STATE UNIVERSITY-EXTENSION CAMPUS ₱19,940.00 AT HIMAMAYLAN CITY WEST VISAYAS STATE UNIVERSITY-EXTENSION CAMPUS ₱19,940.00 AT HIMAMAYLAN CITY 05/02/2013 05/02/2014 SOCIAL STUDIES TEACHER Hua Siong College of Iloilo ₱ 14,000.00 N/A CONTRACTUAL NO SIGNATURE (Continue on separate sheet if necessary) October 15, 2021 C S FORM 212 (Revised 2017), Page 2 of 4 DATE

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 29. NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES NUMBER OF HOURS POSITION / NATURE OF WORK (Write in full) (mm/dd/yyyy) From To N/A N/A N/A N/A N/A (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. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS INCLUSIVE DATES OF ATTENDANCE Type of LD CONDUCTED/ SPONSORED BY (Write in full) ( Managerial/ (Write in full) (mm/dd/yyyy) NUMBER OF HOURS Supervisory/ Online Course on Strategic Planning: Using Balanced Scorecard T echnical/ et c) Development Academy of the Philippines From To 40 Department of Human Settlement and Urban Development 9/20/2021 9/24/2021 Technical National Economic and Development Authority Commission on Higher Education Region VI/ West Geographic Information System Training 9/13/2021 9/17/2021 40 Technical Visayas State University Rescue 177 Training Center Project Evaluation and Development (PED) Course 3/5/21 5/15/2021 40 Technical West Visayas State University Faculty Training for the New General Education Core Courses 06/05/2018 06/10/2018 48 T echnical National Commission for Culture and the Arts 2nd National Summit on Disaster Skills Training/Workshop and NSTP Convention 04/11/2018 04/13/2018 24 T echnical University of the Philippines Visayas Local Curriculum Review of the New Teacher Education Programs 02/08/2018 02/08/2018 8 T echnical West Visayas State University BANTULA: International Conference on Culture-Based Education in the Context of ASEAN Integration 12/01/2017 12/03/2017 24 T echnical State Universities and Colleges Teacher Educators Association 2017 UPV Graduate Reaserch Conference 11/11/2017 11/11/2017 8 T echnical Commission on Higher Education Region VI/ West Visayas State University 32nd Agency Research In-House Review 10/04/2017 10/06/2017 24 T echnical Philippine Sociological Society National Historical Commission of the Philippines 2017 SUCTEA International Seminar and Research Conference 09/14/2017 09/16/2017 24 T echnical Commission on Higher Education Region VI/ West Visayas State U Center for the Professional Advancement of Educators Student Financial Assistance Program Regional Orientation-Conference 10/11/2016 10/11/2016 7 Supervisory SACEDA YOUTH LEAD West Visayas State University National Conference of The Philippine Sociological Society 10/07/2016 10/08/2016 16 Technical University of the Philippines Visayas Research Office-WVSU Himamaylan Campus Philippine-Spanish Frienship Day Conference 09/09/2016 09/09/2016 8 Technical U.P DILIMAN-College of Social Sciences and Philosophy 05/15/2016 05/18/2016 28 Technical Center for the Professional Development of Academic National Implementation of Senior High School Teacher Training for Local and State Universities and 04/29/2016 05/01/2016 32 Technical Leaders and Supervisors Colleges Hua Siong College of Iloilo National Seminar-Workshop on the Preparation of Instructional Materials for the K to 12 Classroom Hua Siong College of Iloilo Department of Education, Region 6 National Training for Teachers Teaching Social Studies and History 02/26/2016 02/28/2016 24 Technical Department of Education, Region 6 CATALYST for Professional Development Services Intellectual Property Orientation Seminar 11/20/2015 11/20/2015 8 Technical 2015 UPV Graduate Research Conference 11/07/2016 11/07/2015 8 Technical 3rd Research Proposal Training Workshop 10/28/2015 10/29/2015 14 Technical 2015 Summer Training Workshop for Social Science Teachers 04/14/2015 04/17/2015 28 Technical Seminar-workshop on Formative Assessment and Differentiated Instruction 07/13/2013 07/14/2013 14 Technical Seminar-workshop on Strengthening Teacher Competencies & Skills in Teaching 05/30/2013 05/30/2013 8 Technical Seminar-workshop on Personal and Professional Effectiveness and the Contemporary Teacher 05/28/2013 05/28/2013 8 Technical 2013 In-Service Training for Grade Eight Teachers of Private Schools 04/27/2013 04/30/2013 16 Technical Designing, Assessing and Facilitating Grade 8 Learning Units based on the K to 12 Standards 04/27/2013 04/30/2013 16 Technical Teaching The Digital Generation: Powerful Teaching Strategies for 21st Century Learners 02/02/2013 02/02/2013 7 Technical VIII. OTHER INFORMATION (Continue on separate sheet if necessary) 31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION 33. MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full) (Write in full) Computer literate N/A ASOSASYON NG MGA DALUBHASA MAY HILIG AT Gardening INTERES SA KASAYSAYAN NG PILPINAS STATE UNIVERSITIES AND COLLEGES TEACHER EDUCATORS ASSOCIATION Social Networking PHILAST (Continue on separate sheet if necessary) SIGNATURE DATE October 15, 2021 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 the YES NO chief of bureau or office or to the person who has immediate supervision over you in the Office, NO Bureau or Department where you will be apppointed, YES a. within the third degree? b. within the fourth degree (for Local Government Unit - Career Employees)? If YES, give details: 35. a. Have you ever been found guilty of any administrative offense? YES NO N/A N/A If YES, give details: b. Have you been criminally charged before any court? YES NO 36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by If YES, give details: any court or tribunal? Date Filed: N/A Status of Case/s: N/A YES NO If YES, give details: ______________________________N_/A_ 37. Have you ever been separated from the service in any of the following modes: resignation, retirement, YES NO dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or private sector? If YES, give details: 38. a. Have you ever been a candidate in a national or local election held within the last year (except YES NO N/A Barangay election)? NO N/A If YES, give details: N/A b. Have you resigned from the government service during the three (3)-month period before the last election to promote/actively campaign for a national or local candidate? YES N/A 39. Have you acquired the status of an immigrant or permanent resident of another country? If YES, give details: N/A 40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); N/A and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: YES NO N/A a. Are you a member of any indigenous group? If YES, give details (country): b. Are you a person with disability? YES NO NO c. Are you a solo parent? If YES, please specify: NO YES If YES, please specify ID No: YES If YES, please specify ID No: 41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) NAME ADDRESS TEL. NO. ILOILO CITY RANDY M. MADRID ID picture taken within the last 6 months DR. NANCY S. SURMIEDA WEST VISYAS STATE UNIVERSITY 320-0870 3.5 cm. X 4.5 cm (passport size) PROF. HILDA C. LORILLA WEST VISYAS STATE UNIVERSITY 320-0870 With full and handwritten 42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete name tag and signature over statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agenc printed name Computer generated or photocopied picture is not acceptable PHOTO Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance Government Issued ID: BIR-TIN ID/License/Passport No.: 435-705-676 Signature (Sign inside the box) Date/Place of Issuance: 05/08/2013/ ILOILO CITY October 15, 2021 Right Thumbmark Date Accomplished SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above. Person Administering Oath CS FORM 212 (Revised 2017), Page 4 of 4



AACCUP Level 1 Accreditation BEED I.2 Sample printed programs for planning activity Attendance sheet of participants Minutes of the meeting Pictures of the planning activity