CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 ABOY
NAME EXTENSION (JR., SR)
FIRST NAME RHEA MAR

MIDDLE NAME MATULA

3. DATE OF BIRTH
(mm/dd/yyyy) 06/05/1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH BOLISONG, MANJUYOD NEGROS ORIENTAL 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 N/A
Widowed Separated House/Block/Lot No. Street
N/A BOLISONG
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 5'3 MANJUYOD NEGROS ORIENTAL
City/Municipality Province
8. WEIGHT (kg) 68 KILO ZIP CODE

9. BLOOD TYPE N/A

18. PERMANENT ADDRESS N/A N/A
House/Block/Lot No. Street
10. GSIS ID NO. N/A
N/A BOLISONG
Subdivision/Village Barangay
MANJUYOD NEGROS ORIENTAL
11. PAG-IBIG ID NO. 1210-7239-8973
City/Municipality Province

12. PHILHEALTH NO. 1205-1142-5463 ZIP CODE 6208

13. SSS NO. 07-27961008 19. TELEPHONE NO. N/A

14. TIN NO. 337-940-279 20. MOBILE NO. 9353625481

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
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)
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 ABOY 11/3/1964

NAME EXTENSION (JR., SR)
FIRST NAME JERRY

MIDDLE NAME BLAZA

25. MOTHER'S MAIDEN NAME

SURNAME MATULA 3/11/1962

FIRST NAME MARJORIE

MIDDLE NAME GANAGANAG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BOLISONG ELEMENTARY SCHOOL ELEMENTARY 1999 2006 GRADUATED 2005-2006

VOCATIONAL
SECONDARY / MANJUYOD NATIONAL HIGH SCHOOL HIGH SCHOOL 2007 2010 GRADUATED 2009-2010

N/A N/A
TRADE BACHELOR OF ELEMENTARY
COLLEGE
COURSE NEGROS ORIENTAL STATE UNIVERSITY 2014 2017 GRADUATED 2016-2017
EDUCATION
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE August 7, 2020

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 76.8 9/24/2017 CEBU CITY 1570201

(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 (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
in full/Do not abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
CUSTOMER SERVICE
11/6/2017 7/28/2018 TELETECH DUMAGUETE 12000.00 N/A REGULAR N/A
REPRESENTATIVE
CUSTOMER SERVICE FIXED
11/13/2019 1/9/2020 QUALFON DUMAGUETE 12000.00 N/A TERM/CONTRACTUAL N/A
REPRESENTATIVE
DEPARTMENT OF EDUCATION NEGROS
8/14/2018 11/29/2018 SUBSTITUTE TEACHER 20754.00 N/A CONTRACTUAL N/A
ORIENTAL
DEPARTMENT OF EDUCATION NEGROS
1/7/2020 2/17/2020 SUBSTITUTE TEACHER 20754.00 N/A CONTRACTUAL N/A
ORIENTAL
DEPARTMENT OF EDUCATION NEGROS
2/18/2020 3/17/2020 SUBSTITUTE TEACHER 22316.00 N/A CONTRACTUAL N/A
ORIENTAL

(Continue on separate sheet if necessary)

AUGUST 7, 2020
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

(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 ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
PROGRAMS(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
RAMS ART TRAINING AND ASSESSMENT CENTER
BREAD AND PASTRY PRODUCTION 9/18/2017 10/13/2018 141 HOURS
INC.

MID-YEAR IN SERVICE TRAINING 10/22/2018 10/26/2018 40 HOURS SAGRADA ELEMENTARY SCHOO/DEPED NEGOR

VIA ZOOM/COLLEGE OF EDUCATION, UP

CHARGED UP: PRIORITIZING SELF-CARE FOR THE NEW NORMAL 6/16/2020 6/16/2020
DILLIMAN
VIA ZOOM/COLLEGE OF EDUCATION, UP
PROVIDING PSYCHOSOCIAL SUPPORT 6/19/2020 6/19/2020
DILLIMAN
THE LEARNING DURING PANDEMIC: IMPLICATIONS TO STUDENT- VIA ZOOM/COLLEGE OF EDUCATION, UP
6/23/2020 6/23/2020
CENTERED EMERGENCY EDUCATION DILLIMAN
TEACHING BEYOND SUBJECTS: TAPPING CONNECTIONS AMONG VIA ZOOM/COLLEGE OF EDUCATION, UP
6/26/2020 6/26/2020
LEARNING AREAS DILLIMAN
CONTEXTUALIZING CURRICULAR PRIORITIES: INCLUSIONIN THE TIME OF VIA ZOOM/COLLEGE OF EDUCATION, UP
6/30/2020 6/30/2020
COVID-19 DILLIMAN
VIA ZOOM/COLLEGE OF EDUCATION, UP
ENACTING FLEXIBLE LEARNING OPTIONS 7/3/2020 7/3/2020
DILLIMAN
VIA ZOOM/TEFL PROFESSIONAL DEVELOPMENT
TEACHING ENGLISH AS A FOREIGN LANGUAGE 5/27/2020 6/10/2020 120 HOURS
INS.
VIA ZOOM/QUEENSLAND UNIVERSITY OF
BULLYING IN SCHOOLS: HOW SHOULD TEACHERS RESPOND 6/21/2020 6/30/2020 10 HOURS
TECHNOLOGY
SUPPORTING ADOLESCENT LEARNERS: SOCIAL AND EMOTIONAL
7/2/2020 7/2/2020 6 HOURS VIA ZOOM/GRIFFIT UNIVERSITY
WELLBEING

(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 full)
(Write in full)

COMPUTER LITERATE AND BAKING N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 7, 2020

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
YES ✘ NO
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, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased 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
YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the YES ✘ NO
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
BOLISONG, MANJUYOD NEGROS the last 6 months
FLORDELUNA B. BENDIJO ORIENTAL
9367928790 3.5 cm. X 4.5 cm
(passport size)
BUTONG, MANJUYOD NEGROS
IRENE A. BANJAO 9759434128 With full and handwritten
ORIENTAL name tag and signature over
printed name
GUILLERMO T. ESONA JR. BAIS CITY, NEGROS ORIENTAL 9652044167
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
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: PRC

ID/License/Passport No.: 1570201

Signature (Sign inside the box)
AUGUST 7, 2020
Date/Place of Issuance: 12/11/2017/DUMAGUETE CITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 7th of August, 2020 , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

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