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Personal Data Sheet

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PERSONAL DATA SHEET – NBC 461

NOTE: THIS FORM WILL BE FILLED BY THE FACULTY MEMBERS OF A STATE COLLEGE/UNIVERSITY

INSTRUCTIONS:

1. FILL OUT THIS FORM ACCURATELY AND LEGIBLY, TYPEWRITTEN OR HANDWRITTEN. REFER TO ATTACHED NOTES FOR DETAILS. 2. FOR ADDITIONAL SPACE, USE THE SAME SIZE OF BOND PAPER. FOLLOW THE SAME FORMAT.

|Name: |
|Date of Birth: |Sex: Female Male |
|Civil Status: |
|Home Address: |Tel. No.: |
|Mailing Address: |Tel. No.: |
|College: |
|Department: |
|Present Rank / Sub Rank: |
|Status of Appointment: |
|Annual Salary: |
|Date of Last Appointment / NOSA: |

1. EDUCATIONAL QUALIFICATION

1. Highest relevant academic degree or educational attainment and additional equivalent degree earned related to the present position.
|DEGREE EARNED |SPECIALIZATION |INSTITUTION |YEAR OBTAINED |
| | | | |
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2. Additional credits earned towards an appropriated higher degree.
|BACCALAUREATE |MASTERAL |DOCTORAL |
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| | | |

2. EXPERIENCE AND LENGTH OF SERVICE

1. Service Record (includes full-time teaching, research, extension service, administrative experience and industrial experience)
|INCLUSIVE DATE |POSITION HELD |INSTITUTION / ADDRESS |
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3. PROFESSIONAL DEVELOPMENT, ACHIEVEMENT AND HONORS.

1. Innovations, patented inventions with patent pending, publications and other creative works.
|NATURE OF INNOVATIONS / INVENTIONS |PATENT NUMBER |YEAR PATENTED |
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3.1.2 – 3.1.5 Published books, research, monographs, articles, instructional manual, workbooks, films, compositions.
|Nature (books, article, films, instructional |Complete Title |Role |Publisher |Date of Publication |
|materials) | | | | |
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2. Expert Services, Training and Active Participation in professional / technical activities.

1. Training Courses and Seminars (including academic, technical, agro-industrial and fishery training)

A. Training
|Title of Training |Sponsoring Agency |Level (Int’l, Nat’l, Local, Inst’l) |Inclusive Dates |
| | | | |
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B. Conferences, Seminars, etc.
|Title of Conference |Sponsoring Agency |Inclusive Dates |
| | | |
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| | | |
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2. Expert Services

A. Consultancy
|Nature / Area of Consultancy |Country |Sponsoring Agency |Inclusive Dates |
| | | | |
| | | | |
| | | | |
| | | | |

B. Active Expert services rendered as coordinator, lecturer, resource person, guest speaker in conferences, workshops and/on training courses.
|Title of Conference, Seminar, Workshop, etc. |Nature of Participants |Sponsoring Agency |Inclusive Dates |
| | | | |
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C. For expert services as adviser in doctoral dissertation and masteral thesis.
|Title of Paper |Nature |Inclusive Dates |
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D. For Certified services (includes reviewer/examiner in PRC or CSC, accreditation work, trade skill certification, service as coach/trainer, adviser of student organization.
|Nature / Area |Company / Agency |Inclusive Dates |
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3.3 Membership in professional organizations, honors societies and honors received

1. Membership in professional organization / honor societies.
|Name of Organization |Date of Membership |
| | |
| | |
| | |
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2. Academic honors received
|Honors Received |Degree Obtained |Institution / Address |
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3. Scholarship / Fellowship
|Title of Scholarship |Nature (Competitive: Int’l, Nat’l, Reg’l, Local) (Non-Competitive: |Sponsoring Agency |Inclusive Dates |
| |Int’l/Reg’l/Local) | | |
| | | | |
| | | | |
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3. Awards of distinction received in recognition of achievement in relevant areas of specialization/profession/assignment.
|Title of Award of Distinction (Institutional Materials) |Field of Services |Grantee Organization |Level: Int’l/Nat’l/Reg’l/ |
| | | |Local/Institutional |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |

4. Community Outreach. Service-oriented projects participated in the community.
|Name of Project |Participation / Service |Sponsoring Agency |Inclusive Dates |
| | | | |
| | | | |
| | | | |
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5. Professional Examinations
|Title of Examination |Date of Examination |Rating |
| | | |
| | | |
| | | |
| | | |
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D. Research recommendations transformed to public policy benefiting to the country, and other creative works.
|Complete Title of Research |Level: Int’l/Nat’l/ |Sponsoring Agency |Inclusive Dates |
| |Reg’l/Local/Inst’l | | |
| | | | |
| | | | |
| | | | |
| | | | |
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E. Supervision, tutoring, or coaching of graduates scientists and technologies.
|Nature/Area of Supervision/ |Country | |Level: Int’l/Nat’l/ |Inclusive Dates |
|Tutoring coaching | |Sponsoring Agency |Reg’l/Inst’l | |
| | | | | |
| | | | | |
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| | | | | |

F: Research results applied or utilized in industrial and/or commercial projects or undertaking
|Complete Title of Research |Level: Int’l/Nat’l/Reg’l |Sponsoring Agency |Inclusive Dates |
| |Local/Inst’l | | |
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I hereby certify to the correctness of these statements.

Signature of Faculty Member

Subscribed and sworn to before me this day of affiant exhibiting to me his/her Residence Certificate issued in on .

Noted by:

< your head > < position >

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