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 N

I. PERSONAL INFORMATION
2. SURNAME Salgado
NAME EXTENSION (JR., SR)
FIRST NAME Phoebe
MIDDLE NAME Galas
3. DATE OF BIRTH
(mm/dd/yyyy) 10/1/1987 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birthby naturalization
4. PLACE OF BIRTH Malaybalay City If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS Purok 5 Ge-melina

Widowed Separated House/Block/Lot No. Street
Other/s: Tablon
Subdivision/Village Barangay
7. HEIGHT (m) 161 Cagayan de Oro City Misamis Oriental
City/Municipality Province
8. WEIGHT (kg) 73.8 ZIP CODE
18. PERMANENT ADDRESS Purok 5 Ge-melina
9. BLOOD TYPE O+
House/Block/Lot No. Street
Tablon
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 210-8398-2338 Cagayan de Oro City Misamis Oriental

City/Municipality Province
12. PHILHEALTH NO. 15-050233514-8 ZIP CODE 9000
13. SSS NO. 08-17552339-8 19. TELEPHONE NO. 088-859-1785
14. TIN NO. 308-400-460 20. MOBILE NO. 0926-3843-080
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME Salgado 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME Winston Xander Nathan G. Salgado 3/14/2012
MIDDLE NAME Tubo
OCCUPATION Filling Machine Operator
EMPLOYER/BUSINESS NAM Cofipac Corporation

BUSINESS ADDRESS Umalag, Tablon, Cagayan de Oro City

TELEPHONE NO. 088-855-5462
24. FATHER'S SURNAME Galas
SR
FIRST NAME Elmer

MIDDLE NAME Salva

25. MOTHER'S MAIDEN NAME

SURNAME Caintic

FIRST NAME Virginia

MIDDLE NAME Garcia (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND HIGHEST
LEVEL/

NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE SCHOLARSHIP/

26. PERIOD OF ATTENDANCE UNITS YEAR
ACADEMIC
LEVEL (Write in EARNED GRADUATE
HONORS
(Write in full) full) D
From To (if not RECEIVED
graduated
1ST Honorable
ELEMENTARY Anahawon Elementary School Primary Education 1994 2000 N/A) 2000 Mention

VOCATIONAL
SECONDARY /
Bukidnon National School of
Secondary 2000 2005 N/A 2005 N/A
Home Industries
N/A
TRADE Bachelor of Science in Office
COLLEGE
COURSE Central Mindanao University 2005 2010 2010 N/A
Administration
GRADUATE STUDIES Southern Philippine College Professional Education 2017 21
(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
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

Licensure Examination for Teachers 81.4 10/25/2018 Cagayan de Oro City 1653719 10/1/2021

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

Grade 11 Step
09/20/2019 Present Te acher 1 Department of Education 20,754.00 1 Permanent Y

6/6/2018 3/31/2019 Teacher King of Zion School 8000.00 Contractual N

Regular/Resi
8/8/2016 1/9/2018 Sales Executive Ecu Worldwide Philippines INC. 17000.00 N
gned
Regular/Resi
10/8/2015 7/28/2016 Marketing Manager K5 Plus Logistics 12000.00 N
gned
Ferad Enterprises and Manpower Regular/Resi
10/24/2013 03/05/2014 HR Assistant 8500.00 N
Services gned
Regular/Resi
03/08/2014 02/28/2015 Branch Coordinator Multi-line Ventures Corp. 8500.00 N
gned
Regular/Resi
10/11/2010 05/13/2012 Selling Assistant(OIC) Surplus Marketing Corporation 9000.00 N
gned

(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

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

PC Operations Tutorials 3/25/2019 4/5/2019 80 DATS Technical Training Center, INC

CINEMAGIES 01/23/2019 01/26/2019 32 Xavier University

CREATIVITY: Making Ideas Happen 11/16/2018 11/16/2018 8 Phonex & Sibs Publishing House Inc.

NATIONAL SEMINAR-WORKSHOP ON
TEACHING AND LEARNING OF SOCIAL
STUDIES(ARALING PANLIPUNAN) WITH
INTERGRATION AND CONTEXTUALIZATION Center for Professional Advancement of
10/12/2018 10/14/2018 24
WITH A THEME: ''THE TEACHING AND Educators
LEARNING OF SOCIAL STUDIES IN THE 21ST
CENTURY''. (WITH CPD 15 CREDITS, PRC-CPD
ACCREDITATION NO.2017-067-1137)

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Singing N/A N/A

(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 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 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
a.
items:
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
Elaine Joyce Duran Davao City 9989729881 3.5 cm. X 4.5 cm
(passport size)

Amie Tapdasan, MAEd, PhD Units Cagayan de Oro City 9273317496 With full and handwritten
name tag and signature over
printed name
Ursulo Cristal Baloy, Cagayan de Oro City 9261568283
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 PHOTO
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

ID/License/Passport No.: 1653719

Signature (Sign inside the box)

Date/Place of Issuance: 06/22/2018

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