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 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 (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME DEASMIN
NAME EXTENSION (JR,SR) N/A
FIRST NAME JELMER

MIDDLE NAME OBIENA

3. DATE OF BIRTH
1/10/1993 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
✘
birth naturalization
4. PLACE OF BIRTH SARAYAN,MATALAM,COTABATO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS N/A N/A

Widowed House/Block/Lot No. Street

Separate
PUROK 7 BATO
Other/s: d
Subdivision/Village Barangay
MATALAM COTABATO
7. HEIGHT (m) 1.71 m
City/Municipality Province
8. WEIGHT (kg) 54 kg ZIP CODE 9406

O+ 18. PERMANENT ADDRESS N/A N/A

9. BLOOD TYPE
House/Block/Lot No. Street
PUROK 7 BATO
10. GSIS ID NO. 200-507-8923
Subdivision/Village Barangay
MATALAM COTABATO
11. PAG-IBIG ID NO. 1212-0318-2366
City/Municipality Province

12. PHILHEALTH NO. 17-250278538-4 ZIP CODE 9406

13. SSS NO. 09-3782395-2 19. TELEPHONE NO. N/A

14. TIN NO. 472-521-368 20. MOBILE NO. 09468866240

15. AGENCY EMPLOYEE NO. 4921817 21. E-MAIL ADDRESS (if any) deasminj1993@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS
[

TELEPHONE NO.

24. FATHER'S SURNAME DEASMIN

SR.
FIRST NAME ELMER

MIDDLE NAME LUMAGA

25. MOTHER'S MAIDEN NAME

SURNAME OBIENA

FIRST NAME RODELA

MIDDLE NAME SORIANO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL PERIOD OF HIGHEST LEVEL/
26. SCHOLARSHIP/
BASIC EDUCATION/DEGREE/COURSE ATTENDANCE UNITS YEAR
LEVEL (Write in EARNED GRADUATED ACADEMIC HONORS
(Write in full) RECEIVED
full) (if not graduated)
From To
FIRST HONORABLE
ELEMENTARY SARAYAN ELEMENTARY SCHOOL PRIMARY EDUCATION 2000 2006 GRADUATED 2006 MENTION
VOCATIONAL /
SECONDARY SARAYAN HIGH SCHOOL HIGH SCHOOL 2006 2010 GRADUATED 2010 SALUTATORIAN

N/A

TRADE COTABATO FOUNDATION COLLEGE OF SCIENCE BACHELOR IN SECONDARY EDUCATION

COLLEGE
COURSE AND TECHNOLOGY (CFCST) MAJOR IN BIOLOGY
2010 2014 GRADUATED 2014 CUM LAUDE

GRADUATE STUDIES N/A

(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 79.20% 3/29/2015 DAVAO CITY 1383417 1/10/2018

(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. GOV'T
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/
DEPARTMENT OF EDUCATION -AGUSTIN M. N)
1/1/2019 PRESENT TEACHER - I VALDEVIESO SR. HIGH SCHOOL- BATO EXTENSION P20,179 "11-1" PERMANENT YES
DEPARTMENT OF EDUCATION -AGUSTIN M.
1/1/2018 12/31/2018 TEACHER - I VALDEVIESO SR. HIGH SCHOOL- BATO EXTENSION P20,179 "11-1" PERMANENT YES
DEPARTMENT OF EDUCATION -AGUSTIN M.
1/1/2017 12/31/2017 TEACHER - I VALDEVIESO SR. HIGH SCHOOL- BATO EXTENSION P19,620 "11-1" PERMANENT YES
DEPARTMENT OF EDUCATION -AGUSTIN M.
8/8/2016 12/31/2016 TEACHER - I VALDEVIESO SR. HIGH SCHOOL- BATO EXTENSION P19,077 "11-1" PERMANENT YES

(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
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION (Write
in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

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

RPMS 09/27/2018 09/29/2018 24 TECHNICAL DALAPITAN HIGH SCHOOL

MATALAM NATIONAL HIGH SCHOOL-POBLACIOB/MATALAM

MUNICIPAL ROLL-OUT ON COMPREHENSIVE SCHOOL SAFETY AND CONTINGENCY PLANNING 10/23/2017 10/23/2017 8 TECHNICAL DISTRICT

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION

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

COMPUTER LITERATE N/A PARENTS AND TEACHERS ASSOCIATION (PTA)

COTABATO PUBLIC SCHOOL TEACHERS, ADMINISTRATION, EMPLOYEES

COOKING AND RETIREES

DRIVING

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/1/2018 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 ✘ NO
YES
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./CP NO.

ID picture taken within
the last 6 months
HON. DANILO ANGCANAN BATO,MATALAM,COTABATO 9090146324 3.5 cm. X 4.5 cm
(passport size)

RONALD C. IGNACIO ALIMODIAN,MATALAM, COTABATO 9192216478 With full and handwritten

name tag and signature over
printed name
JOCEL A. DEVELOS BATO,MATALAM,COTABATO 9505997576
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
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: BIR

ID/License/Passport No.: 472-521-368

Signature (Sign inside the box)

Date/Place of Issuance: 07/24/2015/ KIDAPAWAN 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