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 CABUSAS
NAME EXTENSION (JR., SR)
FIRST NAME CATHERINE

MIDDLE NAME ALIA

3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
✘ Filipino Dual Citizenship
8/3/1979
by birth by naturalization
4. PLACE OF BIRTH SAN FERNANDO CEBU If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS SITIO LAGUNA
6 CIVIL STATUS Single ✘ Married House/Block/Lot No. Street
Widowed Separated BUOT
Other/s:
Subdivision/Village Barangay
CEBU CITY CEBU
7. HEIGHT (m) 5
City/Municipality Province
8. WEIGHT (kg) 62KGS. ZIP CODE 6000
18. PERMANENT ADDRESS SITIO LAGUNA
9. BLOOD TYPE A+
House/Block/Lot No. Street
BUOT
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO. CEBU CITY CEBU

City/Municipality Province
12. PHILHEALTH NO. ZIP CODE 6000

13. SSS NO. 19. TELEPHONE NO. NONE

14. TIN NO. 223-644-029 20. MOBILE NO. 09653779034

15. AGENCY EMPLOYEE NO. 4181464 21. E-MAIL ADDRESS (if any) catherine.cabusas001@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CABUSAS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME ANGELITO

NAME EXTENSION (JR., SR) RENZ A. CABUSAS 11/12/2004

MIDDLE NAME CANSANCIO RHEZ A. CABUSAS 5/14/2010

OCCUPATION DRIVER RHEZIL KHATE A. CABUSAS 6/17/2016

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ALIA

NAME EXTENSION (JR., SR)
FIRST NAME CATALINO

MIDDLE NAME PARADERO

25. MOTHER'S MAIDEN NAME

SURNAME GENERALAO

FIRST NAME ENREQUITA

MIDDLE NAME TAPIAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE
UNITS
YEAR
ACADEMIC
LEVEL (Write in full) GRADUATED HONORS
(Write in full) EARNED
(if not RECEIVED
From To
graduated)
ELEMENTARY NORTH CENTRAL SCHOOL 1992

VOCATIONAL
SECONDARY / NOTRE DAME ACADEMY 1996

TRADE
COLLEGE
COURSE CEBU NORMAL UNIVERSITY 2000
UNIVERSITY OF SAN JOSE
GRADUATE STUDIES RECOLETOS 24UNITS
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

LICENSURE EXAMINATION FOR TEACHERS 75.4 8/22/2000 UNIVERSITY OF THE VISAYAS 0657247 8/3/2025

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

3/7/2003 PRESENT TEACHER 1 DEPARTMENT OF EDUCATION CEBU 28766.00 STEP 7 REGULAR

YES
CITY DIVISION PERMANENT

(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
(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
30. TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
From To Technical/etc)

MID-YEAR IN-SERVICE TRAINING 1/29/2024 1/30/2024 40 DEPARTMENT OF EDUCATION

FOR TEACHERS 1/24/2024 1/26/2024

8/12,9/29/2022 9/30,10/1/2022 32 DEPARTMENT OF EDUCATION

DISTRICT BASED IN-SERVICE TRAINING
SCHOOL- BASED MID-YEAR IN-SERVICE
TRAAINING
MID-YEAR IN-SERVICE TRAINING FOR TEACHERS 12/14/2020 12/19/2020 48 DEPARTMENT OF EDUCATION

MID-YEAR IN-SERVICE TRAINING FOR TEACHERS 10/21/2019 10/25/2019 40 DEPARTMENT OF EDUCATION

RPMS-PPST ORIENTATION 527/2019 5/29/2019 24 DEPARTMENT OF EDUCATION

MASS TRAINING OF GRADE 1 AND GRADE 7 ON 5/16/2018 5/18/2018 24 DEPARTMENT OF EDUCATION
SPED
DEMONSTRATOR DURING SCHOOL BASED 10/27/2017 10/27/2017
MIDYEAR INSET
MID-YEAR IN-SERVICE TRAINING FOR TEACHERS 10/25/2017 10/30/2017 24 DEPARTMENT OF EDUCATION

DISTRICT-BASED MIDYEAR IBSET 10/23/2017 10/24/2017 16 DEPARTMENT OF EDUCATION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
31. SPECIAL SKILLS and HOBBIES NON-ACADEMIC DISTINCTIONS / RECOGNITION 33. ASSOCIATION/ORGANIZATION
(Write in full) (Write in
full)
COOKING AND FLOWER ARRANGING & N/A N/A
DESIGNING

(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 by any court or tribunal? YES ✘ NO
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or YES ✘ NO
phased out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year
(except Barangay election)? YES ✘ NO
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last 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
MAXIMO C. ANIANA JR. DevEdD 3.5 cm. X 4.5 cm
(passport size)
MA.ELENA S. BACAYAN With full and handwritten
name tag and signature over
printed name

Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
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 administrative/criminal case/s against me. PHOTO

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.: 0657247

Signature (Sign inside the box)

Date/Place of Issuance: CEBU 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