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 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 No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME CORDERO
FIRST NAME CHRISTELLE JOY NAME EXTENSION (JR., SR) N/A

MIDDLE NAME OMBOY

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 4/12/1995 ✘ Filipino Dual Citizenship
by by
4. PLACE OF BIRTH REGIONAL HOSPITAL, COTABATO CITY If holder of dual citizenship, birth
Pls. naturalization
indicate country:
please indicate the details.
5. SEX
Male ✘ Female
6 CIVIL STATUS ✘ Single Married
17. RESIDENTIAL ADDRESS BLOCK 1 ZONE 2C
House/Block/Lot No. Street
Separate BULA
Widowed
Other/s: d Subdivision/Village Barangay

7. HEIGHT (m) 1.52 GENERAL SANTOS CITY SOUTH COTABATO

City/Municipality Province
8. WEIGHT (kg) 80 ZIP CODE 9500

9. BLOOD TYPE A
18. PERMANENT ADDRESS BLOCK 1 ZONE 2C
House/Block/Lot No. Street

10. GSIS ID NO. 021-1857-6190-4 BULA

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-1493-0074 GENERAL SANTOS CITY SOUTH COTABATO

City/Municipality Province

12. PHILHEALTH NO. 17-250872231-7 ZIP CODE 9500

13. SSS NO. N/A 19. TELEPHONE NO. 877-4437

14. TIN NO. 711-621-928 20. MOBILE NO. 09257625242 / 09307760908

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
4927330 21. E-MAIL ADDRESS (if any) christellejoy.cordero@deped.gov.ph
N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME CORDERO

NAME EXTENSION (JR., SR)
FIRST NAME CLINIT IAN
N/A
MIDDLE NAME ORBIGOZO
25. MOTHER'S MAIDEN NAME

SURNAME CORDERO
FIRST NAME EUNICE
MIDDLE NAME OMBOY (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/
26. PERIOD OF ATTENDANCE YEAR SCHOLARSHIP/
BASIC EDUCATION/DEGREE/COURSE UNITS
LEVEL (Write in EARNED
GRADUATED ACADEMIC HONORS
(Write in full) RECEIVED
full) (if not graduated)
From To

ELEMENTARY BULA CENTRAL ELEM. SCHOOL ELEMENTARY 2001 2007 N/A 2003 N/A

BULA NAT'L SCHOOL OF

SECONDARY /
VOCATIONAL HIGH SCHOOL 2007 2011 N/A 2007 N/A
FISHERIES
RAMON MAGSAYSAY MEMORIAL
HOUSEKEEPING 2015 2016 N/A 2016 N/A
COLLEGES
TRADE
RAMON MAGSAYSAY MEMORIAL BACHELOR OF SECONDARY
COURSE
COLLEGE
EDUCATION MAJOR IN FILIPINO 2011 2016 N/A 2016 DEAN'S LIST
COLLEGES
GRADUATE STUDIES N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE (Continue on separate sheet if necessary)

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR ROMANA ACHARON C. ELEMENTARY

79.33% 9/24/2016 1517507
TEACHERS SCHOOL- GENERAL SANTOS CITY

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

DEPARTMENT OF EDUCATION - ANTONINO PERMANEN

01/01/2019 PRESENT TEACHER I G. BUSANO SR. HIGH SCHOOL
20,754 "11-1" T
DEPARTMENT OF EDUCATION - ANTONINO PERMANEN
01/01/2018 12/31/2018 TEACHER I G. BUSANO SR. HIGH SCHOOL
20,179 "11-1" T
DEPARTMENT OF EDUCATION - ANTONINO PERMANEN
09/26/2017 12/31/2017 TEACHER I G. BUSANO SR. HIGH SCHOOL
19,620 "11-1" T

01/27/2017 05/23/2017 TUTOR EXCELSIOR LEARNING CENTER 5,000 N/A PART-TIME

 (Continue on separate sheet if necessary)

SIGNATURE DATE 3/15/19

CS FORM 212 (Revised
 LICENSE (if applicable)

Date of
Validity

12/4/2022

eparate sheet if necessary)

GOV'T SERVICE

(Y/
N)

YES

YES

YES

NO
eparate sheet if necessary)

3/15/19
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

AWANA ORGANIZATION PHILIPPINES, INC. 10/11/2013 9/4/2014 60 LEADER AND TEACHER

AWANA ORGANIZATION PHILIPPINES, INC. 3/7/2016 9/4/2017 108 LEADER AND TEACHER

(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
PAMBANSANG SEMINAR-WORKSHOP SA PAGSULAT NG
2/27/2019 1/3/2019 27 TECHNICAL DEPARTMENT OF EDUCATION REGION XII
KORESPONDENSYANG PAMBANSA, AT MANWAL SA MASINOP NA PAGSULAT
LEADERSHIP MANAGEMENT & ENHANCEMENT 01/27/2019 01/29/2017 30 TECHNICAL DEPARTMENT OF EDUCATION REGION XII
PHILIPPINE ASSOCIATION FOR
REGION XII STUDENTS' CONGRESS 2016 4/3/2016 4/4/2016 9 TECHNICAL
TEACHERS AND EDUCATORS REGION XII
RAMON MAGSAYSAY MEMORIAL
BUILDING 21ST CENTURY TEACHERS THROUGH K+12 CURRICULUM 09/19/2015 09/19/2015 9 TECHNICAL
COLLEGES
RAMON MAGSAYSAY MEMORIAL
INTRODUCTION TO LINGUISTICS 01/14/2015 01/14/2015 2 TECHNICAL
COLLEGES
PAGTUTURO NG FILIPINO SA KTO12 AT ANG PAGTATALAKAY SA ISTATUS RAMON MAGSAYSAY MEMORIAL
02/15/2014 02/15/2014 8 TECHNICAL
NG FILIPINO BILANG WIKANG PANTURO COLLEGES
AWANA ORGANIZATION PHILIPPINES,
SEED PLANTERS TRAINING 1/11/2013 2/11/2013 18 TECHNICAL
INC.

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

BACK-UP SINGER VOICE OF HOPE BAND HOPE CHURCH

RAMON MAGSASAY MEMORIAL
WRITER SCHOOL PUBLICATION
COLLEGES SCHOOL PUBLICATION

(Continue on separate sheet if necessary)

SIGNATURE DATE 3/15/19

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 ✘
b. within the fourth degree (for Local Government Unit - Career Employees)? YES
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
MATTY B. NAPOLES BRGY.FATIMA, GEN. SANTOS CITY 09332384101 3.5 cm. X 4.5 cm
(passport size)
ROCA SUBD. BRGY. APOPONG,
SITE AISHA S. TANOG 09212507360 With full and handwritten
GENERAL SANTOS CITY name tag and signature over
PRK.4, BRGY.CONEL, GEN. printed name
JENNILYN C. MADRIDENOS 09104334166
SANTOS CITY 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
PROFESSIONAL REGULATION
Government Issued ID:
COMMISSION
ID/License/Passport No.: 1517507 Signature (Sign inside the box)

3/15/19
Date/Place of Issuance: 1/16/2016 GENERAL SANTOS CITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

LINAMEN C. CATAS
Administrative Officer IV
Person Administering Oath

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