CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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

MIDDLE NAME BUKLATIN

3. DATE OF BIRTH
(mm/dd/yyyy)
MARCH 27, 1971 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH BILUSO, SILANG, CAVITE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 229 N/A

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
N/A POOC I
Other/s:
Subdivision/Village Barangay
SILANG CAVITE
7. HEIGHT (m) 1.60 m
City/Municipality Province
8. WEIGHT (kg) 60 kg ZIP CODE 4118
18. PERMANENT ADDRESS 229 N/A
9. BLOOD TYPE "A"
House/Block/Lot No. Street
N/A POOC I
10. GSIS ID NO. 2002676801
Subdivision/Village Barangay
SILANG CAVITE
11. PAG-IBIG ID NO. 103000019076
City/Municipality Province

12. PHILHEALTH NO. 080000360655 ZIP CODE 4118

13. SSS NO. N/A 19. TELEPHONE NO. 0464430857

14. TIN NO. 122143047 20. MOBILE NO. 09684917104

15. AGENCY EMPLOYEE NO. 2018333 21. E-MAIL ADDRESS (if any) maribel.videna@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME VIDEÑA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME ZOILO N/A VIDEÑA, JANVIR LORD BUKLATIN 06/27/1996

MIDDLE NAME REYES VIDEÑA, JOZXA LOVLE BUKLATIN 04/29/2000

OCCUPATION FARMER xxx xxx

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME BUKLATIN

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

MIDDLE NAME MIRANDA

25. MOTHER'S MAIDEN NAME

SURNAME BARBUCO

FIRST NAME JUANITA

MIDDLE NAME REYES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

Honorable
ELEMENTARY BILUSO ELEMENTARY SCHOOL ELEMENTARY 1977 1983 GRADUATED 1983
Mention

SECONDARY CAVITE INSTITUTE HIGH SCHOOL 1983 1987 GRADUATED 1987 N/A

VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE COURSE

TECHNOLOGICAL UNIVERSITY OF THE BACHELOR OF SCIENCE IN INDUSTRIAL EDUCATION MAJOR IN

COLLEGE CIVIL TECHNOLOGY 1987 1992 GRADUATED 1992 ADB Scholar
PHILIPPINES AT CAVITE
PHILIPPINE CHRISTIAN UNIVERSITY -
GRADUATE STUDIES MASTERS OF ARTS IN EDUCATION 2000 2020 45 UNITS N/A N/A
DASMARIÑAS
(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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSURE EXAMINATIONS FOR TEACHERS 75.9 AUGUST 1-2, 1998 MANUEL L. QUEZON UNIVERSITY - MANILA 506983 03/27/2024

xxx xxx xxx xxx xxx xxx

(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.
INCLUSIVE DATES SALARY/ JOB/ PAY
28.
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/ APPOINTMENT
(Y/ N)
From To INCREMENT

02/01/2022 PRESENT TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱29,798.00 13-3 PERMANENT Y

03/01/2021 01/31/2021 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱28,905.00 13-3 PERMANENT Y

01/01/2021 02/28/2021 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱27,703.00 13-3 PERMANENT Y

01/01/2020 12/31/2020 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱27,383.00 13-3 PERMANENT Y

01/31/2019 12/31/2019 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱25,861.00 13-3 PERMANENT Y

01/01/2019 01/30/2019 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱25,545.00 13-2 PERMANENT Y

01/01/2018 12/31/2018 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱24,510.00 13-2 PERMANENT Y

01/01/2017 12/31/2017 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱23,517.00 13-2 PERMANENT Y

01/31/2016 12/31/2016 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱22,328.00 13-2 PERMANENT Y

01/01/2016 01/30/2016 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱22,328.00 13-1 PERMANENT Y

01/31/2013 12/31/2015 TEACHER III DASMARIÑAS INTEGRATED HIGH SCHOOL ₱21,436.00 13-1 PERMANENT Y

06/01/2012 01/30/2013 TEACHER II DASMARIÑAS INTEGRATED HIGH SCHOOL ₱19,940.00 12-1 PERMANENT Y

06/01/2011 05/31/2012 TEACHER II DASMARIÑAS INTEGRATED HIGH SCHOOL ₱18,333.00 12-1 PERMANENT Y

02/01/2011 05/31/2011 TEACHER II DASMARIÑAS INTEGRATED HIGH SCHOOL ₱16,726.00 12-1 PERMANENT Y

06/24/2010 01/31/2011 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱16,419.00 PERMANENT Y

07/01/2009 06/23/2010 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱15,072.00 PERMANENT Y

07/01/2008 06/30/2009 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱12,951.00 PERMANENT Y

06/07/2008 06/30/2008 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱11,774.00 PERMANENT Y

07/01/2007 06/06/2008 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱11,486.00 PERMANENT Y

06/07/2005 06/30/2007 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱10,442.00 PERMANENT Y

06/07/2002 06/06/2005 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱10,188.00 PERMANENT Y

07/01/2001 06/06/2002 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱9,939.00 PERMANENT Y

01/01/2000 06/30/2001 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱9,466.00 PERMANENT Y

06/07/1999 12/31/1999 TEACHER I DASMARIÑAS INTEGRATED HIGH SCHOOL ₱8,605.00 PERMANENT Y

xxx xxx xxx xxx xxx xxx xxx xxx

(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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(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
INCLUSIVE DATES OF Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
LEARNING ACTION CELL SESSION ON: REVISIT THE UPDATE ON IMPLEMENTATION OF RESULTS-BASED MANAGEMENT PROGRAM
SYSTEM - PHILIPPINE PROFESSIONAL STANDARDS FOR TEACHERS SY 2021-2022 03/03/2022 03/04/2022 8 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL

CAPACITY BUILDING ON MICROSOFT TECHNOLOGIES IN EDUCATION: TEACHBACK SERIES (GAME-BASED LEARNING WITH
MINECRAFT EDUCATION EDITION) 02/18/2022 02/18/2022 5 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL

DASMARIÑAS INTEGRATED HIGH SCHOOL IN-SERVICE TRAINING FOR TEACHERS: ENRICHMENT THE SOFTWARE APPS IN
ATTAINING TEACHING AND LEARNING PROCESS FOR TLE-B TEACHERS 02/02/2022 02/04/2022 12 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL

LEARNING ACTION CELL FOR TLE-BOYS TEACHERS ON: EMPOWER PARENTS AS

02/03/2023 02/04/2022 8 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL
LEARNING PARTNERS
PRIORITIZING WELL-BEING: MENTAL HEALTH STRATEGIES FOR TEACHERS AND
01/31/22 01/31/22 4 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL
EMPLOYEES
OFFICE OF THE UNDERSECRETARY FOR
VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 08/30/2021 09/03/2021 40 TECHNICAL
ADMINISTRATION (OUA)
DASMARIÑAS INTEGRATED HIGH SCHOOL IN-SERVICE TRAINING FOR TEACHERS: ESTABLISHING A POSITIVE CLASSROOM
TOWARDS LEARNER-CENTERED EDUCATION ADDRESSING DIVERSITY IN LEARNING 03/15/2021 03/19/2021 20 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL

CONTINUING PROFESSIONAL DEVELOPMENT

21ST CENTURY TEACHING ADMINISTRATION ONLINE SEMINAR WORKSHOP 02/06/2021 02/13/2021 24 TECHNICAL
CENTER FOR TEACHERS TRAINING CENTER
02/28/2021 CONTINUING PROFESSIONAL DEVELOPMENT
CURRENT TRENDS IN TEACHING INTERNATIONAL ONLINE TRAINING 03/07/2021 24 TECHNICAL
03/06/2021 CENTER FOR TEACHERS TRAINING CENTER
02/07/2021 CONTINUING PROFESSIONAL DEVELOPMENT
ENHANCED RESEARCH CAPABILITY SEMINAR-WORKSHOP ONLINE 02/14/2021 24 TECHNICAL
02/08/2021 CENTER FOR TEACHERS TRAINING CENTER

DASMARIÑAS INTEGRATED HIGH SCHOOL IN-SERVICE TRAINING FOR TEACHERS 12/14/2020 12/18/2020 20 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL

INTERNATIONAL ONLINE TEACHER TRAINING: BUILDING BRIDGES TO THE NEW CONTINUING PROFESSIONAL DEVELOPMENT
11/02/2020 11/28/2020 40 TECHNICAL
NORMAL CENTER FOR TEACHERS TRAINING CENTER
DEPARTMENT OF INFORMATION AND
GRAPHIC DESIGN USING CANVA 09/10/2020 09/10/2020 2 TECHNICAL
COMMUNICATIONS TECHNOLOGY
ORIENTATION ON LEARNING DELIVERY MODALITIES COURSE 2 FOR LEARNING ACTION DEPARTMENT OF EDUCATION CITY SCHOOLS
09/03/2020 09/03/2020 4 TECHNICAL
CELL LEADERS AND TEACHERS DIVISION OF DASMARIÑAS
LEARNING ACTION CELL SESSION ON: ROLE OF FIRST-TIME ADVISER, FIRST-TIME PARENTS SCHOOL YEAR 2020-2021 AND
DIFFERENT KINDS OF SCHOOL FORMS 09/03/2020 09/04/2020 16 TECHNICAL DASMARIÑAS INTEGRATED HIGH SCHOOL

DEPARTMENT OF EDUCATION DASMARIÑAS IN THE NEW NORMAL: ONLINE DISTANCE DEPARTMENT OF EDUCATION CITY SCHOOLS
07/21/2020 07/21/2020 8 TECHNICAL
LEARNING USING MOODLE DIVISION OF DASMARIÑAS
DEPARTMENT OF EDUCATION CITY SCHOOLS
FOSTERING MENTAL WELLNESS: MOTIVATING AND INSPIRING SELF AND OTHERS 08/20/2020 08/20/2020 4 TECHNICAL
DIVISION OF DASMARIÑAS
DEPARTMENT OF EDUCATION CITY SCHOOLS
FOSTERING MENTAL WELLNESS: COPING WITH STRESS 08/19/2020 08/19/2020 4 TECHNICAL
DIVISION OF DASMARIÑAS
FOSTERING MENTAL WELLNESS: UNDERSTANDING MENTAL HEALTH AND DEPARTMENT OF EDUCATION CITY SCHOOLS
08/18/2020 08/18/2020 4 TECHNICAL
PSYCHOSOCIAL SUPPORT DIVISION OF DASMARIÑAS
FOSTERING MENTAL WELLNESS: UNDERSTANDING DISAPPOINTMENT AND DEPARTMENT OF EDUCATION CITY SCHOOLS
08/17/2020 08/17/2020 4 TECHNICAL
DEPRESSION DIVISION OF DASMARIÑAS
CAREER PROGRESSION AND SPECIALIZATION PROGRAM WEBINAR - THE PROFESSIONAL DEVELOPMENT PLAN: CREATING
CAREER ROADMAPS FOR PROFESSIONAL EXCELLENCE 08/14/2020 08/14/2020 4 TECHNICAL PROFESSIONAL REGULATION COMMISSION
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A N/A

MULTI TASKING

xxx

(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:
N/A
35. a. Have you ever been found guilty of any administrative offense? YES NO
If YES, give details:
N/A

b. Have you been criminally charged before any court? YES NO

If YES, give details:
Date Filed: N/A
Status of Case/s: N/A
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:
________________________________
N/A
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: N/A
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: N/A
39. Have you acquired the status of an immigrant or permanent resident of another country? YES NO
If YES, give details (country):
N/A
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: N/A
b. Are you a person with disability? YES NO
If YES, please specify ID No: N/A
c. Are you a solo parent? YES NO
If YES, please specify ID No: N/A

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

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
Vice Mayor Rex Mangubat Dasmariñas, Cavite 9175520224 4.5 cm. X 3.5 cm
(passport size)
Mayor Socorro Poblete Silang, Cavite 9999905377
Computer generated
Ricardo Loyola Silang, Cavite 09212847319 or photocopied picture
is not acceptable
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: PRC ID

ID/License/Passport No.: 0506983

Signature (Sign inside the box)

Date/Place of Issuance: NOVEMBER 28, 1998 - MANILA

Date Accomplished Right Thumbmark

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

RAYMUNDO B. REYES JR., EdD

School Principal IV
Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4