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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

CS Form
READ THE No. 212 GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
ATTACHED
Revised
Print 2017
legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No.

I. PERSONAL INFORMATION
2. SURNAME BALILING

FIRST NAME ELEONOR

MIDDLE NAME ENRICOSO


3. DATE OF BIRTH
(mm/dd/yyyy) 6/26/1972 16. CITIZENSHIP ✘ Filipino Dual Citi

4. PLACE OF BIRTH MIASIN, SAN PABLO,Z.D.S If holder of dual citizenship,

Male ✘ Female please indicate the details.


5. SEX

Single ✘ Married 17. RESIDENTIAL ADDRESS N/A


6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
Other/s: PUROK SAN FRANCISCO
Subdivision/Village
7. HEIGHT (m) 1.65 DUMALINAO
City/Municipality
8. WEIGHT (kg) 80 ZIP CODE 7015
9. BLOOD TYPE A+ N/A
House/Block/Lot No.

10. GSIS ID NO. 2005087763 PUROK SAN FRANCISCO


Subdivision/Village

11. PAG-IBIG ID NO. 1211-7821-1517 DUMALINAO


City/Municipality

12. PHILHEALTH NO. 140000982373 ZIP CODE 7015


13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 330 307 054 0000 20. MOBILE NO. 09122937613
15. AGENCY EMPLOYEE NO. 6150868 21. E-MAIL ADDRESS (if any) ebaliling72@gmail.com/tarray
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BALILING 23. NAME of CHILDREN (Write full name and list all)

NAME EXTENSION (JR.,


FIRST NAME NOLI NORLI DEAR E. BALILIN
SR)
MIDDLE NAME BOVIDA NIEL DAVE E. BALILIN
OCCUPATION NATIONAL EVANGELIST/MINISTER OF THE GOSPEL N/A
EMPLOYER/BUSINESS NAME SOLID ROCK MINISTRIES ASS.
BUSINESS ADDRESS ANTIPOLO RIZAL PHILIPPINES
TELEPHONE NO. N/A
24. FATHER'S SURNAME ENRICOSO
NAME EXTENSION (JR., SR)
FIRST NAME DOMINGO
MIDDLE NAME CAPARIDA
25. MOTHER'S MAIDEN NAME

SURNAME VIOLA
FIRST NAME EMELIANA
MIDDLE NAME RENDAL (Continue on separate

III. EDUCATIONAL BACKGROUND


NAME OF SCHOOL
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE
LEVEL (Write in
(Write in full)
full)
NAME OF SCHOOL
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE
LEVEL (Write in
(Write in full)
full)
From To

SAN PABLO CENTRAL


ELEMENTARY PRIMARY EDUCATION 1978 1984
ELEMENTARY SCHOOL
VOCATIONAL /
SECONDARY SAINT ANDREW'S ACADEMY HIGH SCHOOL 1984 1988

PHILIPPINE PHARMACEUTICAL
COMPUTER HARDWARE SERVICING 2014 2014
TECHNOLOGY SCHOOL (TESDA)

JOSEFINA HERRERA CERILLES BACHELOR OF SECONDAY


COLLEGE 2006 2010
TRADE COURSE STATE COLLEGE EDUCATION

GRADUATE STUDIES N/A N/A N/A N/A

SIGNATURE DATE
AL DATA SHEET
nce Sheet shall cause the filing of administrative/criminal case/s against the person concerned.

ORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

✘ Filipino Dual Citizenship


✘ by birth by naturalization

Pls. indicate country:

N/A
Street
LOCUBAN
Barangay
ZAMBOANGA DEL SUR
Province

7015
N/A
Street
LOCUBAN
Barangay
ZAMBOANGA DEL SUR
Province

7015
N/A

09122937613

ebaliling72@gmail.com/tarrayjay26@gmail.com

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NORLI DEAR E. BALILING 4/30/1993

NIEL DAVE E. BALILING 7/5/1996


N/A N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
HIGHEST LEVEL/ YEAR
ACADEMIC
UNITS EARNED GRADUATED
HONORS
(if not graduated)
RECEIVED
SCHOLARSHIP/
HIGHEST LEVEL/ YEAR
ACADEMIC
UNITS EARNED GRADUATED
HONORS
(if not graduated)
RECEIVED

N/A 1984 N/A

N/A 1988 N/A

N/A 2014 N/A

N/A 2010 N/A

N/A N/A N/A

4/17/2018

CS FORM 212 (Revised 2017), Page 1 of 4


IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

N/A N/A N/A N/A N/A N/A

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

DEPARTMENT OF EDUCATION SAN


01/01/2018 PRESENT TEACHER 11 PABLO ZAMBOANGA DEL SUR
22,149.00 "11-1" PROVISIONAL YES

DEPARTMENT OF EDUCATION SAN


06/05/2017 12/31/2017 TEACHER 11 PABLO ZAMBOANGA DEL SUR
22,149.00 "11-1" PROVISIONAL YES

DEPARTMENT OF EDUCATION SAN


6/1/2017 6/1/2018 TEACHER 1
PABLO ZAMBOANGA DEL SUR
19,620.00 "11-1" PROVISIONAL YES

DEPARTMENT OF EDUCATION SAN


### ### TEACHER 1
PABLO ZAMBOANGA DEL SUR
19,077.00 "11-1" PROVISIONAL YES

DEPARTMENT OF EDUCATION SAN


### 3/31/2014 Local Paid PABLO ZAMBOANGA DEL SUR 4,000.00 N/A CONTRACTUAL YES

N/A N/A N/A N/A N/A N/A N/A N/A

SIGNATURE DATE 04/17/2018

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 PO
From To

Anti- Crime Group of the Philippines 2013 2014 N/A Treasurer


Moral Recovery Program (MRP) 2013 2014 N/A Member
SEA-K ASSOCIATION 2002 2005 N/A President
N/A N/A N/A N/A 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 INTERVENTIONS/TRAINING PROGRAMS Type of LD
CON
(mm/dd/yyyy) NUMBER OF HOURS ( Managerial/ Supervisory/
(Write in full) Technical/etc)

From To

District Level In- Service Training for Secondary School Level 10/23/2018 10/27/2018 48 SUPERVISORY DE

DISTRICT ENHANCEMENT TRAINING ON RESULT -BASED


10/26/2016 10/28/2016 24 SUPERVISORY
PERFORMANCE MANAGEMENT SYSTEM (RPMS)
SIX-DAY SKILLS ENHANCEMENT TRAINING FOR
10/21/2016 10/31/2016 70 SUPERVISORY D
TLE,TVL,ALS,& MOBILE TEACHERS
REGIONAL MASS TRAINING OF TEACHERS (MTOT) FOR
5/27/2016 6/10/2017 94 SUPERVISORY
GRADE II ACADEMIC TRACK - TVL AND COMMON TOPICS RE
TESDA TRAINING COURSE 6/7/2016 11/5/2014 280 TECHNICAL TE
K-12 BASIC EDUCATION PROGRAM FOR GRADE 9 FILIPINO
5/12/2014 5/16/2014 48 SUPERVISORY D
TEACHERS
K-12 BASIC EDUCATION PROGRAM FOR GRADE 8 TLE
5/15/2013 5/19/2013 48 SUPERVISORY D
TEACHERS
K-12 BASIC EDUCATION PROGRAM FOR GRADE 7 FILIPINO
6/11/2012 6/13/2012 40 SUPERVISORY D
TEACHERS
HANDA ARAL PROGRAM SUMMER 6/1/2012 6/3/2012 180 SUPERVISORY

MASS TRAINING FOR 2ND YEAR TEACHERS (UBD) 5/23/2011 5/26/2011 24 SUPERVISORY D

MASS TRAINING FOR 1ST YEAR TEACHERS (UBD) 6/3/2010 6/6/2010 24 SUPERVISORY

GSP COUNSIL ENCAMPMENT 21ST 12/72011 12/11/2011 40 SUPERVISORY G


JOS
NCBTS/TSINA AND IPPD TRAINING 6/18/20119 6/19/2009 24 SUPERVISORY

N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

Singing N/A

cooking

Writing Poem/Tula/Balak

N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
LE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

Treasurer
Member
President
N/A

rate sheet if necessary)


MS ATTENDED
ars for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION
DEPARTMENT OF EDUCATION
REGION IX ZAMBOANGA PENINSULA
TESDA ZAMBOANGA DEL SUR

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

PROVENCIAL GOV.PROGRAM

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

GIRLS SCOUT OF THE PHILIPPINES


JOSEFINA HERRERA CERILLES STATE
COLLEGE
N/A

rate sheet if necessary)


MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

N/A

rate sheet if necessary)

04/17/2018

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 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 regulation
YES ✘ NO
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 phased If YES, give details:
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 (except YES ✘ NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
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 with
POBLACION, SAN PABLO, ZAMBOANGA the last 6 months
LIDA A. BORONGAN DEL SUR N/A 3.5 cm. X 4.5 cm
(passport size)
MARCOS VILLAGE, SAN PABLO,
BELMAN B. MANTOS ZAMBOANGA DEL SUR
09196687620 With full and handwri
name tag and signature
POBLACION, SAN PABLO, ZAMBOANGA printed name
MARIA ISIDRA R. DELOS SANTOS DEL SUR
09077740693
Computer generate
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied pictu
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: VOTER'S I.D

ID/License/Passport No.: VIN;7325-0036A-F2672EEB20000


Signature (Sign inside the box)
04/17/2018
Date/Place of Issuance: POBLACION,SAN PABLO,ZAMBO.SUR
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated ab
TORNITO M. GUMINTAD
Person Administering Oath

CS FORM 212 (Revised


If YES, give details:
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________
✘ NO

✘ NO

✘ NO
If YES, give details (country):

✘ NO

✘ NO

✘ NO

ID picture taken within


the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten


name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO

Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.


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