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CS Form (Revised 2005)

PERSONAL DATA SHEET


Print Legibly. Mark appropriate boxes

with and use separate sheet if necessary.

1. CS ID No.

( to be filled up by CSC)

l. PERSONAL INFORMATION
MAGAN

2. SURNAME
FIRST NAME

IRENE

MIDDLE NAME

ARAEZ

4. DATE OF BIRTH (mm/dd/yy)

3. NAME EXTENSION (e.g.Jr.,Sr)


02-21-76

5. PLACE OF BIRTH

16. RESIDENTIAL ADDRESS

MALALAG, DAVAO DEL SUR

6. SEX

Male
Single

7. CIVIL STATUS

Female
XWidowed

Married
Annulled

Others, specify_____

8. CITIZENSHIP

FILIPINO

9. HEIGHT (m)

1.62M

10. WEIGHT (KG)

66 KG.

11. BLOOD TYPE

12. GSIS NO.

9503

ZIP CODE

Separated

PUROK 4, MALALAG COGON, MALUNGON,


SARANGANI PROVINCE

NONE

17. TELEPHONE NO.


18. PERMANENT ADDRESS

PUROK 4, MALALAG COGON, MALUNGON,


SARANGANI PROVINCE
9503

ZIP CODE

NONE

19. TELEPHONE NO.

CRN-006-0076-8530-90

20. E-MAIL ADDRES (if any)

irene_aranez@yahoo.com

13 PAG-IBIG NO.

1890-0022-5351

21. CELLPHONE NO. (if any)

0948 512 7300

14. PHILHEALTH NO.

17-000053258-7

22. AGENCY EMPLOYEE NO.

15. SSS NO.

NONE

6507133

23. TIN

919-033-735

II. FAMILY BACKGROUND


MAGAN

24. SPOUSES SURNAME

DATE OF BIRTH
(mm/dd/yy)

JOYFE

JAN DRABE ARAEZ MAGAN

05-28-95

ERLANDEZ

KENTH JESTER ARAEZ MAGAN

09-23-96

Engine Mechanic

AIRAH JOY ARAEZ MAGAN

07-03-99

ARA KAYE ARAEZ MAGAN

04-23-01

FIRST NAME
MIDDLE NAME
OCCUPATION

25. NAME OF CHILD (Write full name and list all)

EMPLOYER/BUS. NAME
BUSINESS ADDRESS

BRIDAH,SAUDI ARABIA
N/A

TELEPHONE NO.

(continue on separate sheet if necessary)


ARAEZ

26. FATHERS SURNAME

ELPIDIO (DECEASED)

FIRST NAME
MIDDLE NAME

TABANAO

27. MOTHERS MAIDEN NAME


IPON

SURNAME
FIRST NAME

JULITA

MIDDLE NAME
III. EDUCATIONAL BACKGROUND
28.
LEVEL

ELEMENTARY
SECONDARY

NAME OF SCHOOL
(write in full)

MALALAG COGON
ELEMENTARY SCHOOL
MALALAG COCON NATIONAL
HIGH SCHOOL

VOCATIONAL/
TRADE COURSE
COLLEGE
GRADUATE
STUDIES

MINDANAO STATE
UNIVERSITY
RAMON MAGSAYSAY
MEMORIAL COLLEGES

From

To

SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED

N/A

1983

1989

2ND HONORS

1993

N/A

1989

1993

VALEDICTORIAN

N/A

N/A

N/A

N/A

N/A

1998

1993

1998

ENTRANCE
SCHOLAR

2010

2007

2010

DIPLOMA

YEAR
GRADUATED
(if graduated)

HIGHEST
GRADE/LEVEL/UNITS
EARNED

N/A

1989

N/A
N/A

DEGREE COURSE
(Write in full)

BACHELOR OF
ELEMENTARY
EDUCATION
MASTER OF ARTS IN
EDUCATION

INCLUSIVE DATES OF
ATTENDANCE

(Continue on separate sheet if necessary)


Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

29. CAREER SERVICE / RA 1080 (BOAR/ BAR)


UNDER SPECIAL LAWS/ CES/CSEE
LICENSURE EXAMINATION FOR TEACHERS

RATING

DATE OF
EXAMINATION/
CONFERMENT

75%

08-21-1998

PLACE OF EXAMINATION/
CONFERMENT

LICENSE (if applicable)


NUMBER

0612431

DAVAO CITY

DATE OF
RELEASE

12-04-98

(Continue on separate sheet if necessary)


V. WORK EXPERIENCE (include private employment. Start from your current work)
30. INCLUSIVE DATES
(mm/dd/yy)

POSITION TITLE
(write in full)

DEPARTMENT/ AGENCY/
OFFICE/ COMPANY
(Write in full)

MONTHLY
SALARY

SALARY
GRADE
& STEP
INCREMENT
(Format 00.0)

STATUS OF
APPOINTMENT

GOVT
SERVICE
(Yes/No)

00.4

PERMANENT

YES

From

To

6/1/12

Present

TEACHER 1

NORTH MALUNGON

19,111.00

10/7/11

5/31/12

TEACHER 1

NORTH MALUNGON

17,994.00

PERMANENT

YES

6/1/11

10/6/11

TEACHER 1

NORTH MALUNGON

17,765.00

PERMANENT

YES

1/1/11

5/31/11

TEACHER 1

NORTH MALUNGON

16,419.00

PERMANENT

YES

6/24/10

12/31/10

TEACHER 1

NORTH MALUNGON

16,419.00

PERMANENT

YES

1/1/10

6/23/10

TEACHER 1

NORTH MALUNGON

15,072.00

PERMANENT

YES

7/1/10

12/31/09

TEACHER 1

NORTH MALUNGON

15,072.00

PERMANENT

YES

1/1/09

6/30/09

TEACHER 1

NORTH MALUNGON

12,951.00

PERMANENT

YES

10/7/08

12/31/08

TEACHER 1

NORTH MALUNGON

12,951.00

PERMANENT

YES

7/1/08

10/6/08

TEACHER 1

NORTH MALUNGON

12,635.00

PERMANENT

YES

1/1/08

6/30/08

TEACHER 1

NORTH MALUNGON

11,486.00

PERMANENT

YES

7/1/07

12/31/07

TEACHER 1

NORTH MALUNGON

11,486.00

PERMANENT

YES

1/1/07

6/30/07

TEACHER 1

NORTH MALUNGON

10,442.00

PERMANENT

YES

10/7/06
1/1/06
1/1/05
1/1/04
10/7/02
1/1/02
7/1/01
6/20/01
4/20/01
4/1/01
1/31/01
1/1/01
1/1/00
10/7/99

12/31/06
10/6/06
12/31/05
12/31/04
12/31/03
10/6/02
12/31/01
6/30/01
6/19/01
4/19/01
3/31/01
1/30/01
12/31/00
12/31/99

TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1
TEACHER 1

NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON
NORTH MALUNGON

10,442.00
10,188.00
10,188.00
10,188.00
10,188.00
9,939.00
9,939.00
9,466.00
9,466.00
9,466.00
9,466.00
9,466.00
9,466.00
8,605.00

PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT
PERMANENT

YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES

(Continue in separate sheet if necessary)


CSC FORM 212 (Revised 2005) Page 2 of 4.

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC/ NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S


31.

NAME & ADDRESS OF ORGANIZATION

INCLUSIVE DATES
(mm/dd/yy)

NUMBER OF
HOURS

POSITION/ NATURE
OF WORK

(Write in full)
GAGMAYNG KRISTOHANONG KATILINGBAN, MALALAG COGON
CHAPEL

From

To

01-01-09

PRESENT

N/A

CLUSTER LEADER

(Continue on separate sheet if necessary)


VII. TRAINING PROGRAMS (Start from the most recent training)
INCLUSIVE DATES OF
ATTENDANCE
(mm/dd/yy)

32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES


(Write in full)

From

To

ICT
SEMINAR ON PREVENTION OF VIOLENCE AGAINST WOMEN AND THEIR
CHILDREN

11/01/10

DISTRICT INSET

06/01/10

06/04/10

NUMBER OF
HOURS

CONDUCTED/SPONSOREDBY
(Write in full)

40

Notre Dame of Gen. Santos


City

DEPARTMENT OF
EDUCATION

32

DEPARTMENT OF
EDUCATION

(Continue on separate sheet if necessary)


VIII. OTHER INFORMATION

33. SPECIAL SKILLS / HOBBIES

DANCING, PLAYING VOLLEYBALL, KICKBALL,


SOFTBALL & KICKBALL

34. NON-ACADEMIC DISTINCTIONS /


RECOGNITION
(Write in full)
COACH IN DIVISION CHORAL READING - 3RD
PLACE

35. MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
NORTH MALUNGON TEACHERS COOP
AND TEACHERS LEAGUE, MALALAG
COGON TEACHERS LEAGUE

(Continue on separate sheet if necessary)


CSC 212 (Revised 2005) Page 3 of 4

36. Are you related by consanguinity or affinity to any of the following:


YES
a.

b.

Within the third degree (for National Government Employees):


Appointing authority, recommending authority, chief of police, bureau/department or person who has immediate
supervision over you in the Office, Bureau or Department where you will be appointed?

NO

If YES, give details


YES

Within the fourth degree (for Local Government Employees):


Appointing authority or recommending authority where you will be appointed?

NO

If YES, give details


__________________________________________
____________________________________________________________________________________________________________________________________________________________________

YES

37. a. Have you ever been formally charged?

NO

If YES, give details


YES
b. Have you ever been guilty of any administrative offense?

NO

If YES, give details

38. 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

39. Have you ever been separated from the service in any of the following modes: resignation, retirement.. Dropped from rolls,
dismissal, termination, end of term, finished contract, AWOL, or phased out, in public or private sector?

___________________________________________
YES
NO

If YES, give details


___________________________________________
YES
NO

40. Have you ever been candidate in a national or local election (except Barangay election)?

If YES, give details


___________________________________________
YES
NO

41. Pursuant to; (a) Indigenous Peoples Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7177); and (c) Solo
Parents Welfare Act of 2000 (RA 8972), please answer the following items:
a.
Are you a member of any Indigenous group?
b.

If YES, please specify


YES

Are you differently able?

NO

If YES, please specify


c.

YES

Are you a solo parent?

NO

If YES, please specify

42. REFERENCES (persons not related by consanguinity or affinity to applicant / appointee)


NAME

ADDRESS

TEL. NO.
ID picture taken within
The last 6 months
3.5 x 4.5 cm
(passport size)

MALUNGON GAMAY, MALUNGON

MELODIE M. DEMBILDO

CAMELA T. NAIVE

MALALAG COGON, MALUNGON

ARNEDO A. AMASOL

MALALAG, DAVAO DEL SUR / MALALAG


COGON ELEMENTARY SCHOOL
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is true, correct and complete statement
Pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I also authorized the agency head / authorized representative to verify / validate the contents stated herein. I trust that this
information shall remain confidential.

Computer generated
Or Xerox copy of picture
Is not acceptable

PHOTO

33695419

COMMUNITY TAX CERTIFICATE NO


MALALAG COGON, MALUNGON

SIGNATURE (Sign inside the box)

ISSUED AT

01-28-14

April 1, 2014

DATE ACCOMPLISHED
ISSUED ON (mm/dd/yy)

RIGHT THUMBMARK
CS Form 212 (revised 2005) Page 4 of 4