Professional Documents
Culture Documents
Personal Data Sheet
Personal Data Sheet
WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal
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.
I. PERSONAL INFORMATION
2. SURNAME PASCUA
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
OCCUPATION Teacher
8806
8806
287
5764
@gmail.com
CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
MIDDLE NAME Yu
SURNAME Dysam
VOCATIONAL /
TRADE COURSE
N/A N/A N/A
HIGHEST SCHOLARSHIP/
PERIOD OF ATTENDANCE LEVEL/ YEAR
ACADEMIC
GRADUATE
UNITS EARNED HONORS
D
(if not graduated) RECEIVED
To
3rd Honorable
1989 Graduated 1989 Mention
Best in
1993 Graduated 1993
Math
DATE 08/16/2021
CS FORM 212 (Revised 2017), 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
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
(mm/dd/yyyy)
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY
From To
N/A Probationary N
N/A Probationary N
N/A Regular N
N/A Regular N
N/A Regular N
N/A Regular N
N/A Regular N
N/A Regular N
(Continue on separate sheet if necessary)
SIGNATURE DATE 08/16/2021
CS FORM 212
08/16/2021
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
From To
INCLUSIVE DATES OF
30. ATTENDANCE
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS
(mm/dd/yyyy) NUMBER OF HOURS
(Write in full)
From To
2019 Summer In-Service Training (INSET) for Junior High School 06/17/2019 06/19/2019 24.0)
2018 Summer DepEd-PEAC In-Service Training (INSET) for Senior High School
6/8/2018 6/10/2018 24.0)
Teachers in Private School
Continuing Professional Development: An Ethical and Professional Obligation 12/3/2017 12/3/2017 8.0)
Teaching for Meaning and Mastery: Interactive Teaching Strategies and Outcomes-
12/2/2017 12/2/2017 8.0)
Based Assessment for Analysis, Synthesis, Critical and Creative Thinking Skills
Singapore Math - Ratio, Percentage, Fractions and Bar Modeling 11/19/2016 11/19/2016 8.0)
Member/Soloist
Member/Soloist
Chief/Executive/Managerial positions)
Type of LD
( Managerial/CONDUCTED/ SPONSORED BY
Supervisory/ (Write in full)
Technical/etc)
Technical
Republic of the Philippines Department of
Education
Technical
Catholic Educational Association of the
Philippines
Supervisory
Department of Education - Divison of Lapu-lapu
City
Supervisory
Diwa Learning Systems and Bato Balani
Foundation, Inc.
Playing Volleyball
Reading
DATE 08/16/2021
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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation 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,
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? ________________________________
________________________________
Resignation from my previous em
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before 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?
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?
.
If YES, please specify:
b Are you a person with disability?
.
If YES, please specify ID No:
c Are you a solo parent?
.
If YES, please specify ID No:
ils:
_________________
_________________
ils:
_________________
_________________
ils:
_________________
_________________
ils:
_________________
_________________
ils:
_________________
_________________
n from my previous employer
ils (country):
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
PHOTO
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated ab
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