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:      
1.0 EDUCATIONAL QUALIFICATION

1.1 Highest relevant academic degree or educational attainment and additional equivalent degree earned related to the present position.
DEGREE EARNED SPECIALIZATION INSTITUTION YEAR OBTAINED
                       
                       
                       
                       
                       

1.2 Additional credits earned towards an appropriated higher degree.

BACCALAUREATE MASTERAL DOCTORAL
                 
                 
                 
                 
                 

2.0 EXPERIENCE AND LENGTH OF SERVICE

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

3.1 Innovations, patented inventions with patent pending, publications and other creative works.
NATURE OF INNOVATIONS / INVENTIONS PATENT NUMBER YEAR PATENTED
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 

3.1.2 – 3.1.5 Published books, research, monographs, articles, instructional manual, workbooks, films, compositions.
Nature (books, article, films,
Complete Title Role Publisher Date of Publication
instructional materials)
                             
                             
                             
                             
                             
                             
                             
                             
                             
                             
3.2 Expert Services, Training and Active Participation in professional / technical activities.

3.2.1 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
                       
                       
                       
                       
                       

B. Conferences, Seminars, etc.

Title of Conference Sponsoring Agency Inclusive Dates
                 
                 
                 
                 
                 
                 
                 
                 

3.2.2 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,
Nature of Participants Sponsoring Agency Inclusive Dates
etc.
                       
                       
                       
                       
                       

C. For expert services as adviser in doctoral dissertation and masteral thesis.

Title of Paper Nature Inclusive Dates

                 
                 
                 
                 
                 

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

                 
                 
                 
                 
                 
3.3 Membership in professional organizations, honors societies and honors received

3.3.1 Membership in professional organization / honor societies.

Name of Organization Date of Membership
           
           
           
           
           

3.3.2 Academic honors received

Honors Received Degree Obtained Institution / Address

                 
                 
                 
                 
                 

3.3.3 Scholarship / Fellowship

Nature (Competitive: Int’l, Nat’l, Reg’l, Local)
Title of Scholarship Sponsoring Agency Inclusive Dates
(Non-Competitive: Int’l/Reg’l/Local)
                       
                       
                       
                       
                       
3.4 Awards of distinction received in recognition of achievement in relevant areas of specialization/profession/assignment.
Level: Int’l/Nat’l/Reg’l/
Title of Award of Distinction (Institutional Materials) Field of Services Grantee Organization
Local/Institutional
                       
                       
                       
                       
                       

3.5 Community Outreach. Service-oriented projects participated in the community.

Name of Project Participation / Service Sponsoring Agency Inclusive Dates

                       

                       
                       
                       
                       

3.6 Professional Examinations

Title of Examination Date of Examination Rating
                 
                 
                 
                 
                 
D. Research recommendations transformed to public policy benefiting to the country, and other creative works.
Level: Int’l/Nat’l/
Complete Title of Research Sponsoring Agency Inclusive Dates
Reg’l/Local/Inst’l
                       
                       
                       
                       
                       

E. Supervision, tutoring, or coaching of graduates scientists and technologies.

Nature/Area of Supervision/
Level: Int’l/Nat’l/ Inclusive
Tutoring coaching Country Sponsoring Agency
Reg’l/Inst’l Dates
                       
                       
                       
                       
                       
 F: Research results applied or utilized in industrial and/or commercial projects or undertaking
Level: Int’l/Nat’l/Reg’l
Complete Title of Research Sponsoring Agency Inclusive Dates
Local/Inst’l
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       

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      .

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