CS Form No.

212
Revised 2018

PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s agai
concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (D

I. PERSONAL INFORMATION
2. SURNAME BAID
NAME EXTENSION (JR., SR)
FIRST NAME RICHARD

MIDDLE NAME BAID

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 6/15/1978 ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH LOPOC, LABASON, ZAMBO. NORTE If holder of dual citizenship, Pls. indicate coun
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
POB
Other/s:
Subdivision/Village Ba
GUTALAC ZAMBOANG
7. HEIGHT (m) 1.64
City/Municipality Pr
8. WEIGHT (kg) ZIP CODE 7118
65
18. PERMANENT ADDRESS
9. BLOOD TYPE "O+"
House/Block/Lot No. S
SAL
10. GSIS ID NO. LP-78061501974
Subdivision/Village Ba
GUTALAC ZAMBOANG
11. PAG-IBIG ID NO. 940 -559-940
City/Municipality Pr

12. PHILHEALTH NO. 120501331223 ZIP CODE 7118

13. SSS NO. None 19. TELEPHONE NO. None

14. TIN NO. 940559933 20. MOBILE NO. 09353817968

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) baidrichard@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BAID 23. NAME of CHILDREN (Write full name and list all)

NAME EXTENSION (JR., SR) JOSHUA E. BAID

FIRST NAME ALMA
AARON CARL E. BAID
MIDDLE NAME ENGUITO
NEAL DIETHRICH E. BAID
OCCUPATION SELF EMPLOYED

EMPLOYER/BUSINESS NAME BAID DRYGOODS STORE

BUSINESS ADDRESS SALVADOR, GUTALAC,ZN

TELEPHONE NO. None

24. FATHER'S SURNAME BAID

NAME EXTENSION (JR., SR)
FIRST NAME MIGUEL (DECEASED)

MIDDLE NAME PALAHANG

25. MOTHER'S MAIDEN NAME

SURNAME SUMINGUIT

FIRST NAME ERLINDA

MIDDLE NAME TARUC (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/
26. PERIOD OF ATTENDANCE UNITS
LEVEL (Write in (Write in full) EARNED
full) (if not graduated)
From To
ELEMENTARY LABASON CENTRAL SCHOOL GRADUATED 1988 1994 Graduated
SECONDARY UBAY NATIONAL HIGH SCHOOL GRADUATED 1994 1998 Graduated
VOCATIONAL /

NONE NONE NONE NONE NONE

TRADE SALAZAR COLLEGES OF SCIENCE GRADUATED 2000 2004 Graduated
COURSE
COLLEGE
INSTITUTE OF TECHNOLOGY

GRADUATE STUDIES SAINT VINCENT COLLEGE FULL- FLEDGED MA 2007 2015 Graduated
(Continue on separate sheet if necessary)

SIGNATURE DATE Februa

CS FOR
 DATA SHEET
ence Sheet shall cause the filing of administrative/criminal case/s against the person

FORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization
Pls. indicate country:

Street
POBLACION
Barangay
ZAMBOANGA DEL NORTE
Province
7118

Street
SALVADOR
Barangay
ZAMBOANGA DEL NORTE
Province

7118

None

09353817968

baidrichard@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

2/19/2010

4/14/2014

2/26/2018

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1994 Certificates

1998 Certificates
 NONE NONE

2004 Certificates

2015 Certificates
arate sheet if necessary)

February 11, 2018

CS FORM 212 (Revised 2018), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHER

78.20 8/14/2005 cebu city
(LET)

(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 SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy)
(Write in full/Do not MONTHLY SALARY applicable)& STEP
(Format "00-0")/
abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To

DEPARTMENT OF EDUCATION
1/1/2018 PRESENT TEACHER III 23253.00 SG-13 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
1/1/2017 12/31/2017 TEACHER III 23253.00 SG-13 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
1/1/2016 12/31/2016 TEACHER I 20651.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
1/1/2015 12/31/2015 TEACHER I 19940.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
1/1/2014 12/31/2014 TEACHER I 19940.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
6/1/2012 12/31/2013 TEACHER I 19940.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
6/1/2011 5/31/2012 TEACHER I 18333.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
5/9/2011 5/31/2011 TEACHER I 16726.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
6/24/2010 1/1/2011 TEACHER I 16157.00 SG-11 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
7/1/2009 6/23/2010 TEACHER I 14775.00 SG-11- S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
7/1/2008 6/30/2009 TEACHER I 12635.00 SG-10 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
7/1/2007 6/30/2008 TEACHER I 11456.00 SG-10 - S1
ZAMBOANGA DEL NORTE DIVISION
DEPARTMENT OF EDUCATION
6/6/2006 6/30/2007 TEACHER I 10442.00 SG-10 - S1
ZAMBOANGA DEL NORTE DIVISION

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 23, 2019

CS FORM 212
 LICENSE (if applicable)

NUMBER Date of
Validity

0593126 9/19/1999

on separate sheet if necessary)

f duties should be indicated in the attached Work Experience sheet.

GOV'T SERVICE

STATUS OF
APPOINTMENT

(Y/ N)
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES
REGULAR
PERMANENT YES

on separate sheet if necessary)

JANUARY 23, 2019

CS FORM 212 (Revised 2018), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NUMBER OF
NAME & ADDRESS OF ORGANIZATION (Write in full) (mm/dd/yyyy) HOURS POSIT
From To

SCHOOL MOOE LIQUIDATION IN- CHARGE 2016 2017 CHAIRMAN

LIS IN- CHARGE 2015 2016 COORDINATOR

NUTRITIONAL STATUS CONSOLIDATION IN-CHARGE 2015 2016 COORDINATOR

PERSONNEL TRACKING SYSTEM IN CHARGE 2015 2016 COORDINATOR

(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)

INCLUSIVE DATES OF ATTENDANCE Type of LD

30. NUMBER OF ( Managerial/
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS (Write in full) (mm/dd/yyyy) HOURS Supervisory/
Technical/etc)
From To
DIVISION TRAINING WORKSHOP OF THE ENHANCED LEARNING RESOURCE (LR) PORTAL CUM ACCESS ON
10/24/2018 10/26/2018 24 HOUS
BASA PILIPINAS MATERIALS

ERHRIS ROLL ROLL OUT TRAINING OF TRAINERS ( TOT) ON THE SERVICE REQUEST AND EPDS ENCODING
7/26/2018 7/27/2018 16 HOURS
BY SHOOL PERSONNNEL

SEMINRA/ WORKSHOP ON THE ROLL OUT/ CASCADING OF FINANCIAL MANAGEMENTOPERATION MANUAL

5/16/2018 5/20/2018 40 HOURS
(FMOM)

DISTRICT ENHANCEMENT TRAINING ON GRAMMAR AND ORAL LANGUAGE DEVELOPMENT (GOLD) 5/7/2018 5/9/2018 24 HOUS

DIVISION SEMINAR- WORKSHOP ON ACTION RESEARCH FOR THE IMPROVEMENT OF THE ELEMENTARY
4/5/2018 4/6/2018 16 HOURS
AND SCIENCE INSTRUCTION

ONE-DAY SCHOOL-BASED ORIENTATION, TRAINING, AND WORKSHOP ON ENTERPRISE HUMAN RESOURCE

2/2/2018 2/2/2018 8 HOURS
INFORMATION SYSTEM (EHRIS)

PANDISTRITO NA WORKSHAP SA PAGBUO NG BIG BOOK PARA SA BAITANG 1 AT 2 5/26/2016 5/27/2016 16 HOURS

ONE-DAY DIVISION TEACHERS' CONSULTATIVE CONFERENCE 4/6/2016 4/6/2016 8 HOURS

SCHOOL-BASED SEMINAR WORKSHOP/LAC SESSION ON EARLY LANGUAGE, LITERACY AND NUMERACY

10/16/2015 2/26/2016 8 HOURS
(ELLN)

SCHOOL-BASED IN-SERVICE TRAININGS (INSETS) ON 1) CONTEXTUALIZATION, LOCALIZATION AND

INDIGENIZATION, 2) DEMONSTRATION TEACHINGS IN ENGLISH SCIENCE, MATH AND ARALING PANLIPUNAN, 10/24/2016 10/28/2016 40 HOURS
AND 3) BASIC COMPUTER OPERATIONS

TEACHERS: THE OTHER SIDE 2015 CULTURAL AND SPORTS FEST 10/2/2015 10/5/2015 32 HOURS

TEACHERS: THE OTHER SIDE 2015 CULTURAL AND SPORTS FEST 10/2/2015 10/5/2015 32 HOURS

SCHOOL-BASED POLICY GUIDELINES ON CLASSROOM ASSESSMENT FOR THE K TO 12 BASIC EDUCATION

8/1/2015 8/1/2015 8 HOURS
PROGRAM AND E-CLASS RECORD

1ST DIVISION K TO 12 EDUCATION SUMMIT 2014 12/16/2014 12/17/2014 16 HOURS

DISTRICT ECHO ON THE IMPLEMENTATION OF PERSONAL SAFETY LESSONS (PSL) 10/30/2013 10/30/2013 8 HOURS

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION

31. SPECIAL SKILLS and HOBBIES 32.
(Write in full)

COACH OF THE SECOND PLACER IN ESP SONG SOLO(GRADE II) DURING THE DISTRICT VALUES
TYPING MONTH CELEBRATION DEPED GUTALAC I DISTRICT
COACH OF THE SECOND PLACER IN MTAP (GRADE V) DURING THE DISTRICT LEVEL MTAP QUIZ,
CAR DRIVING JANUARY 6, 2018

COOKING

SCRABLE WORD BUILDING

LAWN TENNIS PLAYING

 (Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

CHAIRMAN

COORDINATOR

COORDINATOR

COORDINATOR
parate sheet if necessary)
ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF EDUCATION GUTALAC I

DICTRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

BABAMI BEACH RESORT, MALINTUBOAN,

LABASON, ZAMBO. NORTE

DEPARTMENT OF EDUCATION GUTALAC

CENTRAL SCHOOL GUTALAC I DISTRICT

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

DEPARTMENT OF EDUCATION DIPOLOG

CITY

DEPARTMENT OF EDUCATION DIPOLOG

CITY

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

DEPARTMENT OF EDUCATION DIPOLOG

CITY

DEPARTMENT OF EDUCATION GUTALAC I

DISTRICT

parate sheet if necessary)

MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
33.
(Write in full)
GUTALAC I PUBLIC SCHOOL
TEACHERS ASSOCIATION
ZAMBOANGA DEL NORTE PUBLIC
SCHOOL TEACHERS ASSOCIATION
PHILIPPINE PUBLIC SCHOOL
TEACHERS ASSOCIATION
parate sheet if necessary)

JANUARY 23, 2019

CS FORM 212 (Revised 2018), Page 3 of 4

 34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the
chief of bureau or office or to the person who has immediate supervision over you in the Office,
Bureau or Department where you will be apppointed,
a. within the third degree? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
YES ✘ NO
by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except YES ✘ NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):

40. 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? YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken with
the last 6 months
DANILO B. ALGA GUTALAC, ZAMBOANGA DEL NORTE 09203721324 3.5 cm. X 4.5 cm
(passport size)
ROSENDA G. MIRANDA SALVADOR, GUTALAC, Z.N. 09195551490 With full and handwri
name tag and signature
printed name
JAIME T. TIMOSA GUTALAC, ZAMBOANGA DEL NORTE 09171136819
Computer generate
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied pictu
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein.
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: PRC

ID/License/Passport No.: 0593126

Signature (Sign inside the box)

Date/Place of Issuance: CAGAYAN DE ORO CITY

Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated ab

ONESIMO L. COMA JR.

Person Administering Oath
CS FORM 212 (Revised
 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________
✘ NO

✘ NO

✘ NO
If YES, give details (country):

✘ NO

✘ NO

✘ NO

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO

Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2018), Page 4 of 4