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 aga
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

I. PERSONAL INFORMATION
2. SURNAME MAGARU
NAME EXTENSION (JR., SR
FIRST NAME DEMY
MIDDLE NAME BUENO
3. DATE OF BIRTH
(mm/dd/yyyy) 11/4/1994 16. CITIZENSHIP
✘ Filipino Dual Citizenship

by birth
4. PLACE OF BIRTH FUGU-NORTE TUMAUINI, ISABELA If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. S
Widowed Separated
Other/s:
FUGU
Subdivision/Village Ba
7. HEIGHT (m) 155M TUMAUINI ISA
City/Municipality Pr
8. WEIGHT (kg) 46 ZIP CODE 3325
18. PERMANENT ADDRESS
9. BLOOD TYPE 0
House/Block/Lot No. S

10. GSIS ID NO. N/A FUGU

Subdivision/Village Ba

11. PAG-IBIG ID NO. N/A TUMAUINI ISA

City/Municipality Pr
12. PHILHEALTH NO. N/A ZIP CODE 3325
13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 493-485-753 20. MOBILE NO. 09657049835
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME MAGARU

NAME EXTENSION (JR., SR)
FIRST NAME BLAS
MIDDLE NAME BULAN
25. MOTHER'S MAIDEN NAME

SURNAME BUENO
FIRST NAME IRENE
MIDDLE NAME CARANI (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY FUGU-ABAJO ELEMENTARY SCHOOL ELEMENTARY GRADE 2001 2007 GRADUATE

VOCATIONAL
SECONDARY / FERMELDY NATIONAL HIGH SCHOOL HIGH SCHOOL 2007 2011 GRADUATE
ISABELA SCHOOL OF ARTS AND TRADES- TRAINERS METHODOLOGY LEVEL
2016 2017 GRADUATE
TESDA 1
TRADE ISABELA STATE UNIVERSITY- BACHELOR OF SECONDARY
COLLEGE
COURSE 2011 2015 GRADUATE
CABAGAN EDUCATION

ISABELA STATE UNIVERSITY-

GRADUATE STUDIES MASTERS OF ARTS IN EDUCATION 2017 2018 24 UNITS
CABAGAN
 ISABELA STATE UNIVERSITY-
GRADUATE STUDIES MASTERS OF ARTS IN EDUCATION 2017 2018 24 UNITS
CABAGAN

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE

CS FORM
L DATA SHEET
rience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by birth by naturalization
Pls. indicate country:

Street
FUGU-NORTE
Barangay
ISABELA
Province
3325

Street
FUGU-NORTE
Barangay
ISABELA
Province

N/A
09657049835
[email protected]

DATE OF BIRTH (mm/dd/yyyy)

MARCH 07,1957

SEPTEMBER 19,1956
(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2007 TOP 5

2011 N/A

2017 N/A

SK &
2015
BROED

ON -GOING N/A
 ON -GOING N/A

parate sheet if necessary)

JUNE 28,2018
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

LICENSURE EXAMINATION FOR TEACHERS 77.40 9/27/2015 TUGUEGARAO CITY

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

6/6/2017 4/6/2018 ADMINISTRATIVE ASSISTANT DEPED FERMELDY NATIONAL HIGH SCHOOL 2,000.00 N/A

3/1/2017 4/7/2017 TEACHER 1 SUBSTITUTE DEPED MALAMAG ELEMENTARY SCHOOL 19,077.00 11-1

12/22/2016 3/1/2017 ADMINISTRATIVE ASSISTANT DEPED FUGU ELEMENTARY SCHOOL 2,000.00 N/A
11/4/2016 12/21/2016 TEACHER 1 SUBSTITUTE DEPED TUMAUINI NORTH CENTRAL 19,077.00 11-1
6/13/2016 11-03-2016 ADMINISTRATIVE ASSISTANT DEPED FUGU ELEMENTARY SCHOOL 2,000.00 N/A
6/1/2015 05/31/2016 ADMINISTRATIVE ASSISTANT DEPED FUGU ELEMENTARY SCHOOL 500.00 N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 28,2018

CS FORM 212
 LICENSE (if applicable)

NUMBER Date of
Validity

1404170 11/4/2018

ue on separate sheet if necessary)

of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
LSB YES
TEACHER 1
YES
SUBSTITUTE
LSB YES
TEACHER 1
YES
SUBSTITUTE
LSB YES
LSB YES

ue on separate sheet if necessary)

JUNE 28,2018
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 O
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/ SPONSOR
NUMBER OF HOURS
PROGRAMS (Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

SEMINAR WORKSHOP ON LEARNING EFFECTIVITY

THROUGH ENHANCED PEDAGOGIES FOR THE K-12 01-11-2018 01-12-2018 16 TECHNICAL ISABELA STATE U
BASIC EDUCATION PROGRAM
DEP-ED FERME
IN-SERVICE TRAINING 10-23-2017 10-27-2017 40 TECHNICAL
SC
COMPUTER AC
COMPREHENSIVE COMPUTER OPERATION TRAINING 05-15-2017 05-18-2017 32 TECHNICAL
ASSOCIATION
TRAINERS METHODOLOGY LEVEL 1 1/25/2017 3/15/2017 280 TECHNICAL ISA

COMPUTER SYSTEMS SERVICING NCII 12/8/2015 3/20/2016 400 TECHNICAL TUMAUINI NATI

IN-SERVICE TRAINING 10/24/2016 10/28/2016 40 TECHNICAL FUGU ELEME

IN-SERVICE TRAINING 10/26/2015 10/30/2015 40 TECHNICAL

FUGU ELEMEN

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE

PLAYING SOFTBALL,VOLLEYBALL
 (Continue on separate sheet if necessary)

SIGNATURE DATE JUNE

OVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

tinue on separate sheet if necessary)

S/TRAINING PROGRAMS ATTENDED
ning taken for the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

ISABELA STATE UNIVERSITY-CABAGAN

DEP-ED FERMELDY NATIONAL HIGH

SCHOOL
COMPUTER ACCESS PROVIDERS
ASSOCIATION INCORPORATED
ISAT-TESDA

TUMAUINI NATIONAL HIGH SCHOOL

FUGU ELEMENTARY SCHOOL

FUGU ELEMENTARY SCHOOL

tinue on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
tinue on separate sheet if necessary)

JUNE 28, 2018

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
Bureau or Office,
in the Department where you will be apppointed,
a. within the third degree? YES ✘ N
O
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NON
O
If YES, give details: ________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense? YES ✘ N NO
O
If YES, give details: ________________________________
b. Have you been criminally charged before any court? ________________________________
YES N
If YES, give details: ________________________________
O
________________________________
Date Filed:
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, YES ✘ N
ordinance or regulation by any court or tribunal? O
If YES, give details: ________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: YES N✘
resignation, retirement, dropped from the rolls, dismissal, termination, end of O
If YES, give details: ________________________________
term, finished contract or 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
YES ✘ N
last year (except Barangay election)? O
If YES, give details:
b. Have you resigned from the government service during the three (3)-month YES N
period before the last election to promote/actively campaign for a national or If YES, give details:O
local candidate?
39. Have you acquired the status of an immigrant or permanent resident of another YES ✘ N
country? O
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: IBANAG
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
RONALD M. MASIDDO TUMAUINI, ISABELA 9065753129 3.5 cm. X 4.5 cm
(passport size)

JEYFA C. ELEPONIO TUMAUINI, ISABELA 9363709988 With full and handwritten

name tag and signature over
printed name
SHERYL A. MAGARU TUMAUINI, ISABELA 9366597885
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, or photocopied picture
is not acceptable
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 PHOTO
attachments shall cause the filing of 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.: 1404170 Signature (Sign inside the box)

Date/Place of Issuance: 12/15-2015, TUGUEGARAO CITY

Date Accomplished Right Thumbmark

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

RHODORA G. TAGACAY
Public Schools District Supervisor

Person Administering Oath

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