CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

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.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME TANGPUZ
NAME EXTENSION (JR., SR) N/A
FIRST NAME JOHN ELTON

MIDDLE NAME GALCERAN

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 9/11/1995 ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH QUEZON CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 055 -C KAUNLARAN

Widowed Separated House/Block/Lot No. Street
COMMONWEALTH
Other/s:
Subdivision/Village Barangay
QUEZON CITY METRO MANILA
7. HEIGHT (m) 1.676
City/Municipality Province
8. WEIGHT (kg) 75kg. ZIP CODE 1121

9. BLOOD TYPE A+
18. PERMANENT ADDRESS 055 -C KAUNLARAN
House/Block/Lot No. Street

10. GSIS ID NO. 2006125652 COMMONWEALTH

QUEZON CITY METRO MANILA

11. PAG-IBIG ID NO. 1211-8078-0085
City/Municipality Province

12. PHILHEALTH NO. 03-251390073-1 ZIP CODE 1121

13. SSS NO. 34-3976014-1 19. TELEPHONE NO. N/A

14. TIN NO. 332-031-487-000 20. MOBILE NO. 09161492262

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) tjohnelton@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME DE GUZMAN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) N/A

FIRST NAME JHERMALYN 7/1/1995

MIDDLE NAME ENDRINA

OCCUPATION ASSISTANT IMPORT / EXPORT MANAGER

EMPLOYER/BUSINESS NAME Wynnie's Fababier Customs Brokerage/ACL Trucking

BUSINESS ADDRESS Rm 323 Calvo Bldg Escolta St, Binondo Manila

TELEPHONE NO. 8243-6771

24. FATHER'S SURNAME TANGPUZ 6/13/1968

NAME EXTENSION (JR., SR) N/A
FIRST NAME ANTONIO

MIDDLE NAME LAZADA

25. MOTHER'S MAIDEN NAME GALCERAN 3/5/1972

SURNAME GALCERAN

FIRST NAME HARUMANI

MIDDLE NAME FLORES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY COMMONWEALTH ELEMENTARY SCHOOL PRIMARY EDUCATION 2000 2007 GRADUATED 2007 N/A

SECONDARY /
VOCATIONAL ST. MARK INTERNATIONAL ACADEMY HIGH SCHOOL 2007 2011 GRADUATED 2011 N/A

N/A N/A N/A N/A N/A N/A N/A

TRADE
COURSE PHILIPPINE MARITIME INSTITUTE COLLEGES - BACHELOR OF SCIENCE IN CUSTOMS
QUEZON CITY ADMINISTRATION 2011 2016 GRADUATED 2016 N/A
COLLEGE

UNIVERSITY OF RIZAL SYSTEM - RODRIGUEZ RIZAL CERTIFICATE FOR PROFESSIONAL EDUCATION 2018 2019 18 UNITS 2019 N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHERS (LET)

77.80 3/29/2022 SAN BENDA UNIVERSITY 1926419
2022

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

ST. MARK INTERNATIONAL

06/10/19 04/26/22 TEACHER 9,500 N/A PROVISIONAL
ACADEMY

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
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)
INCLUSIVE DATES OF
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

EVENTS AND MANAGEMENT SERVICES (NCIII) 7/19/2021 7/31/2021 80 HOURS TECHNICAL EASTERN STAR INSTITUTE OF SCIENCE & TECH.

BASIC COMPUTER REPAIR AND TROUBLESHOOTING 8/6/2017 9/3/2017 80 HOURS TECHNICAL XAVIER TECHNICAL TRAINING CENTER CORP.

PAGLIKHA NG MGA PINALATUNTUNANG KAGAMITANG PANTURO TUNGO SA SARILING

6/8/2020 6/8/2020 5 HOURS TECHNICAL VIBAL GROUP ( WEBINAR )
PAGKATUTO NG MGA MAG-AARAL
OPTIMIZING THE CURRICULUM AND LEARNING EXPERIENCE THROUGH MODULAR
6/9/2020 6/9/2020 5 HOURS TECHNICAL VIBAL GROUP ( WEBINAR )
APPROACH

TEACHING SKILL-BASED SUBJECTS IN ONLINE LEARNING PLATFORMS 6/12/2020 6/12/2020 5 HOURS TECHNICAL VIBAL GROUP ( WEBINAR )

DEVELOPING SELF-PACED MODULES FOR BASIC EDUCATION STUDENTS 6/10/2020 6/10/2020 5 HOURS TECHNICAL VIBAL GROUP ( WEBINAR )

"ENHANCING DEVELOPMENTAL MOTIVATION TO SELF-PACED/AUTONOMOUS LEARNING 6/11/2020 6/11/2020 5 HOURS TECHNICAL VIBAL GROUP ( WEBINAR )

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)

COMPUTER BASIC TO ADVANCE PMI COLLEGES - QUEZON CITY N/A

COMPUTER TROUBLESHOOTS N/A N/A

MICROSOFT OFFICE TOOLS N/A N/A

FLEXIBILTY N/A N/A

DETERMINATION N/A N/A

COMMUNICATION SKILLS N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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 by any
YES ✘ NO
court or tribunal?
If YES, give details:
________________________________
________________________________
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 If YES, give details:
public or private sector? FINISHED CONTRACT
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay
YES ✘ NO
election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last election YES ✘ NO
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 within
the last 6 months
Fe E. Tatoy BARANGAY BATASAN, QUEZON CITY 0907-274-3263 3.5 cm. X 4.5 cm
(passport size)
BARANGAY COMMONWEALTH, QUEZON
Jhon Collene I. Gianan CITY
0966-213-9238 With full and handwritten
name tag and signature over
BARANGAY COMMONWEALTH, QUEZON printed name
Jhermalyn E. De Guzman CITY
0956-622-5150
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the 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 administrative/criminal case/s against PHOTO
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 I.D.

ID/License/Passport No.: 1926419

Signature (Sign inside the box)
JUNE 06, 2022 / Philippine International Convention
Date/Place of Issuance:
Center(PICC) Date Accomplished Right Thumbmark

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