Employee Information Sheet (updated) - PDF Templates

Employee Information Sheet (updated) Image-1

EMPLOYEE INFORMATION SHEET

1. PERSONAL INFORMATION

Name

Mr. VINCE ERROL JIMENA LUCAS

Home Address

14 Taft St. Poblacion

Aritao, Nueva Vizcaya

Bayombong Address

Salvacion

Bayombong, Nueva Vizcaya

Date of Birth

Thursday, February 12, 1998

Employee ID Number

2659

Place of Birth

Olongapo City, Zambales

Phone Number

0975-346-0993

Email Address

velucas@smu.edu.ph

GOVERNMENT ISSUED IDs

T.I.N. No.

725-621-517

Current Church Affiliation/Religion

Roman Catholic

SSS No.

01-2760522-3

PAGIBIG No.

1212-1662-0746

PhilHealth No.

06-251080498-3

Ethnicity (Dominant)

Tagalog

Blood Type

A+

EMPLOYEE FAMILY BACKGROUND

Name of Spouse

Church of Marriage

His/Her Occupation

Place of Marriage

Wedding Date

PARENTS

Father's Name

Joselito R. Lucas

Occupation

Tricycle Driver

Occupation

Church Leader

Mother's Name

Evangeline J. Lucas

Employee Information Sheet (updated) Image-1

PARENTS-IN-LAW

Father-in-law's Name

Occupation

Mother-in-law's Name

BROTHERS/SISTERS including half-siblings (eldest to youngest)

	NAME (First Name Middle Initial Last Name)	CURRENT ADDRESS
1	Yvan Joselle J. Lucas	Aritao, Nueva Vizcaya
2	Mitzi Coleen J. Lucas	Aritao, Nueva Vizcaya

CHILDREN (eldest to youngest)

	NAME (First Name Middle Initial Last Name)	BIRTHDATE (MM / DD / YYYY)
1	N/A

2. EDUCATIONAL PREPARATION

A. GRADE SCHOOL/ SECONDARY EDUCATION:

	School Name	School Address	Month & Year of Graduation
Grade School	Saint Teresita's Academy	Aritao, Nueva Vizcaya	2010
High School	Saint Teresita's Academy	Aritao, Nueva Vizcaya	2014
Senior High School	N/A

B. UNDERGRADUATE STUDIES (Bachelor's Degree)

	Degree	Major/Minor	School	Address	S.O. Number	Month & Year of Graduation	Honors Received
1	BSED	English w/ CREED	Saint Mary's University	Bayombong, Nueva Vizcaya	Exempted	June 2018	Cum Laude

C. GRADUATE STUDIES (Masters/Doctorate Degree

	Deg ree	Major /Mino r	Sch ool	Addr ess	S.O . N umb er	Month & Ye ar of Grad uatio n	Hono rs R ecei ved
1	MAT	Englis h	Saint Mar y's Unive rsity	Bayombon g, Nueva Vizcaya		July 2 022	Acade mic D istin ction

D. SPECIAL STUDIES COMPLETED, relevant to your position at Saint Mary's University

	Studies	Institution	Inclusive Dates
1	N/A

3. PROFESSIONAL BOARD/BAR EXAMINATIONS

	Examination	Certificate/ Reg. No.	Date Passed (Month & Year)	Rating	Remarks
1	Licensure Examination for Teachers	1721388	December 2018	83.6	Passed

Has your professional certificate ever been revoked, cancelled or suspended? No
If yes, state if reinstated N/A

4. TEACHING EXPERIENCE

A. GRADUATE LEVEL

	Position/s Held	Institution	Address	Inclusive Dates (Month/Day/Year)	Status
1	N/A

B. COLLEGIATE LEVEL

	Position/s Held	Institution	Address	Inclusive Dates (Month/Day/Year)	Status
1	Faculty Member	Saint Mary's University	Bayombong, Nueva Vizcaya	August 9, 2021 - present	Full-time

C. HIGH SCHOOL LEVEL

	Positi on/s H eld	Inst itut ion	Addr ess	Inclusi ve Date s (Month/ Day/Yea r)	Sta tus
1	Teacher	Saint Mary 's Univers ity - Seni or HS	Bayombong, Nueva Viz caya	Jan. 2018 -May 2018	Part-t ime
	Positi on/s H eld	Inst itut ion	Addr ess	Inclusi ve Date s (Month/ Day/Yea r)	Sta tus
2	Teacher	Saint Tere sita's Aca demy	Aritao, Nu eva Vizcay a	2018-2020	Full-t ime
3	Principal	Southern C agayan Val ley School of Techno logy, Inc.	Aritao, Nu eva Vizcay a	2020-2021	Full-t ime

D. GRADE SCHOOL LEVEL

	Position/s Held	Institution	Address	Inclusive Dates (Month/Day/Year)	Status
1	N/A

5. PROFESSIONAL EXPERIENCES/ OTHERS

List of experiences starting with the least recent and include only FULL- TIME professional work experiences.

	Position/s Held	Agency/ Institution	Address	Inclusive Dates (Month/Day/Year)	Status
1	N/A

6. ADMINISTRATIVE EXPERIENCE

	Name of Firm	Address	Position	Inclusive Dates
1	SCVSTI	Aritao, Nueva Vizcaya	School Principal	2020-2021
2	Saint Mary's University	Bayombong, Nueva Vizcaya	Extension Coordinator, STEH	August 1, 2022 - July 31, 2023
3	Saint Mary's University	Bayombong, Nueva Vizcaya	In-charge, Indigenous Peoples Services Unit, LMCDAC	August 1, 2023 - present

7. PROFESSIONAL BOOKS or ARTICLES AUTHORED and PUBLISHED

	Title	Publisher/Publication	Volume/Year
1	Lesson Videos as Multimodal Materials in SHS Online Classes Using English as MOI	Internatinal Forum on Cultural Studies	2024

8. AWARDS RECEIVED (Regional, National and International)

	Name of Award	Date Awarded	Place	Awarding Body
1	N/A

9. GRANTS RECEIVED (Scholarships, Travel, etc

	Name of Grant	Inclusive Dates	Place	Sponsoring Agency
1	N/A

10. AFFILIATIONS/MEMBERSHIP TO PROFESSIONAL ORGANIZATIONS

	Name of Organization	Position Held	Inclusive Dates
1	Philippine Association for Language Teachers	Member	2019-present

11. TRAININGS, SEMINARS and CONFERENCES ATTENDED

To be provided by HRDO based on the Trainings/Seminars/Conferences attended that were submitted via Jotform)

12. NOMINATED BENEFICIARIES

Failure to Nominate.

If at the death of the SMU employee, there is no existing valid nominated beneficiary, the existing laws on succession shall prevail.

	NAME (First Name Middle Initial Last Name)	RELATIONSHIP
1	Joselito R. Lucas	Father
2	Evangeline J. Lucas	Mother
3	Yvan Joselle J. Lucas	Sister
4	Mitzi Coleen J. Lucas	Sister

DECLARATION

I hereby declare, under penalties of perjury, that the answers/data given are true and correct to the best of my knowledge and belief.

Signature

Signed on

Tuesday, January 28, 2025

DATA PRIVACY NOTICE

We are committed to protect your privacy and ensure that all personal data collected are processed according to the principles of transparency, legitimate purpose, and proportionality pursuant to R.A. 10173 (Data Privacy Act of 2012). The personal data collected herein will be used for the purpose of validating and updating your FILE 201 (Personnel Information) and for accreditation purposes.

Got it.

Employee Information Sheet (updated) Image-1