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 aga

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.

I. PERSONAL INFORMATION
2. SURNAME DAPITON
NAME EXTENSION (JR., SR
FIRST NAME CELSA
MIDDLE NAME BOLOTAOLO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 7/28/1980 ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH Capalaran, Tangub City If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS Purok 1

6 CIVIL STATUS
Widowed Separated
Capalaran
Other/s:
Subdivision/Village
7. HEIGHT (m) 4"11 Tangub City Misam
City/Municipality
8. WEIGHT (kg) 40 kls ZIP CODE 7214
18. PERMANENT ADDRESS Purok 1
9. BLOOD TYPE A+
House/Block/Lot No.
Capalaran
10. GSIS ID NO.
Subdivision/Village

11. PAG-IBIG ID NO.

Tangub City
City/Municipality

12. PHILHEALTH NO. 15-201606133-0 ZIP CODE 7214

13. SSS NO. 08-2478780-0 19. TELEPHONE NO. 09502232376

14. TIN NO. 221-553-244 20. MOBILE NO. 09502232376

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) celsadapiton@gmail.com
DAPITON 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) KATE ELOISE BOLOTAOLO DAPITON
DARWIN

MIDDLE NAME ABANGAN AALIAH BOLOTAOLO DAPITON

OCCUPATION DRILLER JOHN RAIN BOLOTAOLO DAPITON

EMPLOYER/BUSINESS NAME Janeyo Drilling @ Construction Corp. N/A

BUSINESS ADDRESS N/A N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME BOLOTAOLO N/A

NAME EXTENSION (JR., SR) N/A
FIRST NAME PROCULO (Deseased)

MIDDLE NAME N/A N/A

25. MOTHER'S MAIDEN NAME GABICA N/A

SURNAME BOLOTAOLO N/A

FIRST NAME ZENONA N/A

MIDDLE NAME LUMACANG (Continue on separate sheet if necess

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)
 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

1990/6/3 1993/3/3
ELEMENTARY Capalaran Elementary School , Tangub City Elementary Graduate Graduated
0 0

1993/6/3 1997/3/1
SECONDARY Sta. Maria National High School, Tangub City High School Graduate Graduated
VOCATIONAL / 0 9

Northwestern MIndanao School of TESDA - Food & Beverage Services NC

Technology, Tangub City II
356 hrs Graduated
TRADE
Bachelor in Secondary Education 1997/6/1 2001/10/
COURSE Misamis University, Ozamiz City
(BSED) Major in Filipino
Graduated
COLLEGE 5 19

Master of Arts in Education (MAED) Major in 2016/6/1 2017/18/ 18 units

GRADUATE STUDIES Saint Columban College
Filipino 5 17 earned
(Continue on separate sheet if necessary)

SIGNATURE DATE July

CS
L 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) N/A

Dual Citizenship

by naturalization
Pls. indicate country:

Barangay
Misamis Occidental
Province

7214

Street

Barangay
Misamis Occidental
Province

7214

09502232376

09502232376

celsadapiton@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

3/4/2004

2/1/2007

6/20/2011

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

(Continue on separate sheet if necessary)

YEAR SCHOLARSHIP/
GRADUATED ACADEMIC HONORS
RECEIVED
 YEAR SCHOLARSHIP/
GRADUATED ACADEMIC HONORS
RECEIVED

1993 4th Honor

1997 N/A

2009 N/A

2001 N/A

N/A
parate sheet if necessary)

July 12, 2018

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF LICENSE (if applicable
SPECIAL LAWS/ CES/ CSEE (If EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE Applicable) CONFERMENT NUMBER

LET (Licensure Examination for Teacher) 77.2 3/29/2016 Pagadian City 1458334

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

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

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

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

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

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

11/14/2017 1/12/2018 Sub Teacher- 1 Silangit National High School, Tangub 19620.00 G-11 Sub Teacher
Honorarium
8/14/2017 11/14/2017 ALS Instructional Manager Villaba, Tangub City 5,000 Contract

5/28/2014 10/31/2014 Faculty Filipino Instructor Medina College, Ozamiz City 7,800.00 Contract

N/A N/A N/A

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N/A N/A N/A

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE July 12, 2018

CS FORM 212 (Revised 2017), P
 LICENSE (if applicable)

Date of
Validity

6/10/2016

N/A

N/A

N/A

N/A

N/A

N/A

separate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

N
separate sheet if necessary)

July 12, 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 POSITION
From To

N/A

N/A

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/ CONDUC
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
Retooling and Repackaging of ALS Curriculum in Preparation for the
11/30/2017 11/31/2017 16 hrs ALS
Accreditation and Equivalency (A&E) Test
Capacity Enhancement Training for ALS Implementers and Instructional
11/26/2017 11/27/2017 16 hrs ALS
Managers
Table Skirting and Table Setting (Technology-based Community Training
7/18/2017 10/28/2017 80 hrs ALS In
Program)

Food and Beverage Services NC II 8/6/2014 8/6/2019 356 hrs

N/A N/A

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 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 3
(Write in full)
.

Cooking
N/A
Dancing
N/A
Singing
N/A

N/A

N/A

N/A

N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
ENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

N/A

N/A

N/A

N/A

N/A

N/A

NG PROGRAMS ATTENDED
the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

ALS eLearning Center, Tangub City

ALS eLearning Center, Tangub City

ALS InfEd Skills Facilitators, Tangub City

TESDA

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A
on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

N/A

N/A

N/A

N/A

N/A

N/A

N/A
on separate sheet if necessary)

July 12, 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? Finished contract in 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
Josephine Pasiol Tangub City 09129034406 3.5 cm. X 4.5 cm
(passport size)

Lorna C. Penonal Tangub City 09074537724 With full and handwritten

name tag and signature over
printed name
Efleda D. Enerio Ozamiz City 09087618734
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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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 o

 If YES, give details (country):

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

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