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 ag
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 BATANG

FIRST NAME GEMMA

MIDDLE NAME ALEJANDRINO

3. DATE OF BIRTH
(mm/dd/yyyy) SEPTEMBER/01/1981 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by

4. PLACE OF BIRTH CALBAYOG CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed ✘ Separated House/Block/Lot No. S
Other/s: PUROK 1 MAT
Subdivision/Village Ba
CALBAYOG CITY SA
7. HEIGHT (m) 5'2''
City/Municipality Pr
8. WEIGHT (kg) 50 ZIP CODE 6710

18. PERMANENT ADDRESS

9. BLOOD TYPE O+
House/Block/Lot No.
PUROK 1 MAT
10. GSIS ID NO. N/A
Subdivision/Village Ba
CALBAYOG
11. PAG-IBIG ID NO. 1211-9396-2654
City/Municipality Pr

12. PHILHEALTH NO. 13-050188596-8 ZIP CODE 6710

13. SSS NO. 337-3254810 19. TELEPHONE NO. N/A

14. TIN NO. 20. MOBILE NO. 09066977115

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) gemma.batang2@yahoo.co
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BATANG 23. NAME of CHILDREN (Write full name and list all)
JR CHILLZ XZEN A. BATANG
FIRST NAME BALBINO

MIDDLE NAME RAZ CHARRYLINE WIZY A. BATANG

OCCUPATION COCO FARMER BALBINO A. BATANG III

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO.

24. FATHER'S SURNAME ALEJANDRINO

FIRST NAME ARTEMIO N/A

MIDDLE NAME SALINO

25. MOTHER'S MAIDEN NAME STA-ANA

SURNAME ALEJANDRINO

FIRST NAME CONTANCIA

MIDDLE NAME DELOS REYES (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 SAN POLICARPO CENTRAL SCHOOL N/A 1988 1994

SECONDARY SAN POLICARPO NATIONAL HIGH SCHOOL N/A 1994 1998

VOCATIONAL /

NORTHWEST SAMAR STATE UNIVERSITY ASSOCIATE IN COMPUTER SCIENCE Jun-98 Mar-03 CERTIFICATE
TRADE
COURSE BACHELOR OF SCIENCE IN BUSSINESS COLLEGE
COLLEGE NORTHWEST SAMAR STATE UNIVERSITY
ADMINISTRATION MAJOR IN MARKETING
2000 2003
GRADUATE
MASTER OF ARTS MAJOR IN EDUCATIONAL
GRADUATE STUDIES CHRIST THE KING COLLEGE
MANAGEMENT
2013 2014

(Continue on separate sheet if necessary)

SIGNATURE DATE FEB.

CS FORM
L DATA SHEET
erience 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)

N/A

Dual Citizenship
by naturalization

Pls. indicate country:

Street
MATOBATO
Barangay
SAMAR
Province
6710

MATOBATO
Barangay
SAMAR
Province

N/A

09066977115

gemma.batang2@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

12/20/2004

3/9/2007

12/1/2012

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1994 N/A

1998 N/A
 2000 N/A

2003 N/A

N/A N/A

parate sheet if necessary)

FEB. 22, 2018

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

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

N/A

(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

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

FULL TIME
1/6/2016 7/10/1905 TEACHER LA MILAGROSA ACADEMY 7100.00 N/A CONTRACT
UAL
 (Continue on separate sheet if necessary)

SIGNATURE DATE FEB. 22, 2018

CS FORM 212 (Revised 2017),

 LICENSE (if applicable)

Date of
Validity

separate sheet if necessary)

GOV'T
SERVICE

(Y/ N)

N
separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 2 of 4

 VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZAT
INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITIO
From To

DIOCESE OF CALBAYOG CITY 06/15/2015 03/24/16

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

COMPUTER SYSTEM SERVICES 11/26/2017 02/21/2018 280

TRAINERS' METHODOLOGY CERTIFICATE-I 1/5/2017 3/6/2017 264

FOOD & BEVERAGE NC-II 08/26/2015 11/13/2015 336

VIBAL EDUCATION SUMMIT 01/21/2017 01/21/2017 8

INNOVATION CAMP FOR TEACHERS 12/11/2016 12/11/2016 8

VAN-ARALAN COMPUTER PROGRAM 01/18/16 6/2/2016 45

DEVELOPMENT READING CUM ASSESSMENT 06/21/16 06/21/16 8 COLLEGE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION

SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

COMPUTER LITERATE (WORD/EXCEL/POWERPOINT) N/A ALPHA PHI

BAKING/COOKING

DANCING SAMAR IS

SINGING
(Continue on separate sheet if necessary)

SIGNATURE DATE
ON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

CATHECHIST

arate sheet if necessary)

NTERVENTIONS/TRAINING PROGRAMS ATTENDED
D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

STI- CALBAYOG & TESDA

SOS CALBAYOG & TESDA

STI- CALBAYOG & TESDA

VIBAL EDUCATION

DIWA LEARNING SYSTEM

AI-HU FOUNDATION

COLLEGE OF SAN LORENZO RUIZ-CATARMAN

arate sheet if necessary)

R INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

ALPHA PHI OMEGA FRATERNITY & SORRORITY

 TEATRO-DAGWAY

SAMAR ISLAND WOMAN ACTION NETWORK

arate sheet if necessary)

FEBRUARY 22, 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 within
the last 6 months
LOLITA Y. ALERA BLISS, BRGY. BASUD N/A 3.5 cm. X 4.5 cm
(passport size)

GERONIMA J. PEDROSA BRGY. TARABUCAN, OQUENDO DIST. N/A With full and handwritten
name tag and signature over
printed name
LOURDES MATAN BRGY. MAG UBAY, OQUENDO DIST. N/A
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: PHIL. HEALTH

ID/License/Passport No.: 13-050188596-8
Signature (Sign inside the box)
FEB. 22, 2018
Date/Place of Issuance: CALBAYOG CITY
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