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 GAID
NAME EXTENSION (JR., SR) N/A
FIRST NAME MAGNOLIA CLAIRE

MIDDLE NAME FA B E
3. DATE OF BIRTH
04 / 06 / 1994 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH GENERAL SANTOS 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 N/A PUROK MALIPAYON
House/Block/Lot No. Street
Separate
Widowed N/A BUTULAN
Other/s: d Subdivision/Village Barangay
JOSE ABAD SANTOS DAVAO OCCIDENTAL
7. HEIGHT (m) 1.50
City/Municipality Province
8. WEIGHT (kg) 53 ZIP CODE 8014

18. PERMANENT ADDRESS N/A PUROK MALIPAYON

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A BUTULAN
10. GSIS ID NO. 2005076481
Subdivision/Village Barangay
JOSE ABAD SANTOS DAVAO OCCIDENTAL
11. PAG-IBIG ID NO. 121133756227
City/Municipality Province

12. PHILHEALTH NO. 16-25118348-7 ZIP CODE 8014

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 466-893-172-000 20. MOBILE NO. 09555112272

15. AGENCY EMPLOYEE NO. 20161006 21. E-MAIL ADDRESS (if any) magnoliaclaire21@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) N/A

FIRST NAME N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME GAID

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

MIDDLE NAME HANOBAS

25. MOTHER'S MAIDEN NAME

SURNAME FABE

FIRST NAME RUBY

MIDDLE NAME LACIDA (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 KILAKAY ELEMENTARY SCHOOL PRIMARY EDUCATION 2000 2006 GRADUATED 2006 SALUTATORIAN

SECOND
EDNA GUILLERMO MEMORIAL NATIONAL HIGH
SECONDARY /
VOCATIONAL SCHOOL
HIGH SCHOOL 2006 2010 GRADUATED 2010 HONORABLE
MENTION

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

TRADE
GENSANTOS FOUNDATION COLLEGE, BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE
INCORPORATED MAJOR IN ENGLISH
2010 2014 GRADUATED 2014 N/A

N/A N/A N/A N/A N/A N/A 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 Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

LICENSURE EXAMINATION FOR TEACHERS 78.40 08/17/2014 DAVAO CITY 1340352 04/06/2017

(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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
DEPARTMENT OF EDUCATION/EDNA GUILLERMO
01/01/2022 PRESENT TEACHER-1 MEMORIALNATIONAL HIGH SCHOOL
P24,161.00 11-2 PERMANENT YES
DEPARTMENT OF EDUCATION/EDNA GUILLERMO
01/01/2021 12/31/2021 TEACHER-1 MEMORIALNATIONAL HIGH SCHOOL
P24,161.00 11-2 PERMANENT YES
DEPARTMENT OF EDUCATION/EDNA GUILLERMO
01/01/2020 12/31/2020 TEACHER-1 MEMORIALNATIONAL HIGH SCHOOL
P22,600.00 11-1 PERMANENT YES
DEPARTMENT OF EDUCATION/EDNA GUILLERMO
01/01/2019 12/31/2019 TEACHER-1 MEMORIALNATIONAL HIGH SCHOOL
20179.00 11-1 PERMANENT YES
DEPARTMENT OF EDUCATION/EDNA GUILLERMO
01/01/2018 12/31/2018 TEACHER-1 MEMORIALNATIONAL HIGH SCHOOL
P20,179.00 11-1 PERMANENT YES
DEPARTMENT OF EDUCATION/EDNA GUILLERMO
10/13/2016 12/31/2017 TEACHER-1 MEMORIALNATIONAL HIGH SCHOOL
P19,620.00 11-1 PERMANENT YES
DEPARTMENT OF EDUCATION/IGNACIA GUILLERMO
03/04/2016 04/01/2016 SUBSTITUTE TEACHER CENTRAL ELEMENTARY SCHOOL
P18, 549.00 11-1 SUBSTITUTE YES
DEPARTMENT OF EDUCATION/IGNACIA GUILLERMO
01/04/2016 03/03/2016 SUBSTITUTE TEACHER CENTRAL ELEMENTARY SCHOOL
P18, 549.00 11-1 SUBSTITUTE YES
DEPARMENT OF EDUCATION/BUTULAN ELEMENTARY
10/05/2015 12/03/2015 SUBSTITUTE TEACHER SCHOOL
P18, 549.00 11-1 SUBSTITUTE YES
DEPARTMENT OF EDUCATION/BALANGONAN
07/27/2015 09/24/2015 SUBSTITUTE TEACHER ELEMENTARY SCHOOL
P18, 549.00 11-1 SUBSTITUTE YES
DEPARTMENT OF EDUCATION/ANDRES YACON SR.
01/19/2015 03/19/2015 SUBSTITUTE TEACHER ELEMENTARY SCHOOL
P18, 549.00 11-1 SUBSTITUTE YES

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

WEBINAR FOR TEACHERS IN LITERACY INSTRUCTION WITH EMPHASIS ON THE 6 DEPARTMENT OF EDUCATION -DAVAO
05/19/2021 05/19/2021 24 TECHNICAL
ELEMENTS IN READING OCCIDENTAL

LEARNING DELIVERY MODALITIES COURSE 2 11/23/2020 11/27/2020 40 TECHNICAL DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION -DAVAO

PEDAGOGICAL RETOOLING IN MATHEMATICS, LANGUAGE AND SCIENCE 08/20/2019 08/24/2019 40 TECHNICAL
OCCIDENTAL
DEPARTMENT OF EDUCATION -DAVAO
DIVISION ASSEMBLY OF SCHOOL BASED MANAGEMENT PRACTITIONERS 10/11/2018 10/12/2018 16 SUPERVISORY
OCCIDENTAL
DISTRICT ROLL-OUT ON THE CRAFTING OF ENHANCED SCHOOL IMPROVEMENT PLAN DEPARTMENT OF EDUCATION -JOSE ABAD
09/24/2018 09/15/2018 16 SUPERVISORY
(ESIP) AND SCHOOL -BASED MANAGEMENT (SBM) LEVEL OF PRACTICES SANTOS II DISTRICT
DEPARTMENT OF EDUCATION JOSE ABAD SANTOS
DISTRICT ROLL-OUT ON RPMS 8/29/2018 8/30/2018 24 SUPERVISORY
II DISTRICT

(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 LITERATE (MS WORD, MS EXCEL,
N/A N/A
MS POWERPOINT)

(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 ✘ 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? ________________________________
FINISHED CONTRACT
________________________________
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 within

the last 6 months
BUTULAN, JOSE ABAD SANTOS, DAVAO 3.5 cm. X 4.5 cm
CRISANTO P. DULLANO JR. OCCIDENTAL
09161069651 (passport size)

BUTULAN, JOSE ABAD SANTOS, DAVAO With full and handwritten

ARACELI Q. LEBIOS OCCIDENTAL
09051077862 name tag and signature over
printed name
BUTULAN,JOSE ABAD SANTOS, DAVAO
ROSEMARIE B. LEBIOS OCCIDENTAL
09182977466
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and is not acceptable
complete 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 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: PROFESSIONAL REGULATION COMMISSION

ID/License/Passport No.: 1340352

Signature (Sign inside the box)

Date/Place of Issuance: 11/28/2014 / DAVAO CITY

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