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
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 LAGAT
NAME EXTENSION (JR., SR
FIRST NAME RONIE

MIDDLE NAME TAMBOR

3. DATE OF BIRTH
(mm/dd/yyyy) 12/18/1980 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by

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

Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK GARCIA

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
Other/s: SA
Subdivision/Village Ba
GINGOOG CITY MISAMIS
7. HEIGHT (m) 169
City/Municipality Pr
8. WEIGHT (kg) 75 ZIP CODE 9014

18. PERMANENT ADDRESS PUROK 2

9. BLOOD TYPE AB
House/Block/Lot No. S
SA
10. GSIS ID NO. 06-2341552-2
Subdivision/Village Ba
GINGOOG CITY MISAMIS
11. PAG-IBIG ID NO. 1820-0040-2807
City/Municipality Pr

12. PHILHEALTH NO. 15-050108529-6 ZIP CODE 9014

13. SSS NO. 06-2341552-2 19. TELEPHONE NO. N/A

14. TIN NO. 940-104-431 20. MOBILE NO. 09363236237

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
073-1159 21. E-MAIL ADDRESS (if any) ronie_lagat@yahoo.com
LAGAT 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
BEBIE JEAN ALJEYA GYBRIELLE A. LAGAT

MIDDLE NAME ABAN XYZA CLAIRESSE A. LAGAT

OCCUPATION ACCOUNTING CLERK

EMPLOYER/BUSINESS NAME PREMIO-YAMAHA

BUSINESS ADDRESS GINGOOG CITY

TELEPHONE NO. 9362498388

24. FATHER'S SURNAME LAGAT

NAME EXTENSION (JR., SR)
FIRST NAME ELPIDIO
 MIDDLE NAME LAGARET

25. MOTHER'S MAIDEN NAME DECEASED

SURNAME

FIRST NAME

MIDDLE NAME (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 STO.NINO ELEMENTARY SCHOOL ELEMENTARY 6/3/1994 3/30/1995

SECONDARY
VOCATIONAL / CAMIGUIN NATIONAL HIGH SCHOOL SECONDARY 6/13/1995 4/4/1999

TRADE
COURSE
COLLEGE CENTRAL MINDANAO UNIVERSITY TERTIARY 6/13/1999 4/9/2003

GRADUATE STUDIES CARAGA STATE UNIVERISTY GRADUATE STUDIES 8/19/2018 ### 6 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE Septemb

CS FORM
L DATA SHEET
rience 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)

NAME EXTENSION (JR., SR)

Dual Citizenship
by naturalization

Pls. indicate country:

Street
SAN LUIS
Barangay
MISAMIS ORIENTAL
Province
9014

Street
SAN LUIS
Barangay
MISAMIS ORIENTAL
Province

9014

N/A

09363236237

ronie_lagat@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

12/12/2009

4/21/2012
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1995 1ST Honor

Valedictoria
1999
n

DOST
2003
Scholar

parate sheet if necessary)

September 24, 2018

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

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

LICENSURE EXAMINATION FOR TEACHERS 80.0 3/25/2018 CDONHS, NAZARETH, CDOC

CS PROFESSIONAL 82.7 10/17/2004 CITY CENTRAL SCHOOL, CDOC

CS SUBPROFESSIONAL 82.3 7/15/2001 BSU,MALAYBALAY 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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

6/4/2018 PRESENT TEACHER-II DEPED-SAN LUIS NHS 21620.00 SG 12

6/3/2017 5/31/2018 TEACHER-1 DEPED-JDMNHS 19620.00 SG11

1/11/2016 5/31/2017 ADAS-II DEPED-JDMNHS 15931.00 SG 8

3/5/2012 11/30/2015 SALES SUPERVISOR PERSONAL COLLECTION 18982.00

1/31/2011 2/28/2012 GEO EXPANSION MANAGER TECHNOMART 21000.00

4/1/2008 1/30/2011 AREA MANAGER TECHNOMART 16000.00

8/1/2007 3/31/2008 BRANCH MANAGER TECHNOMART 10000.00

6/1/2006 7/31/2007 CREDIT SUPERVISOR TECHNOMART 8000.00

6//1/05 5/31/2006 CREDIT INVESTIGATOR TECHNOMART 7500.00

10/1/2004 12/31/2005 TOURGUIDE TOURMAKERS, PHILIPPINES 2000.00

10/1/2004 2/28/2005 PROJECT CONSOLIDATOR NFA REGION X 4400.00

 (Continue on separate sheet if necessary)

SIGNATURE DATE September 12, 2019

CS FORM 212
 LICENSE (if applicable)

NUMBER Date of
Validity

1643527 7/25/2018

02055809 1/3/2005

01009193 7/23/2001

ue on separate sheet if necessary)

n of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
REG YES

PROBI YES

REG YES

REG NO

REG NO

REG NO

REG NO

REG NO

REG NO

REG NO

J.O NO
ue on separate sheet if necessary)

September 12, 2019

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

NOT APPLICABLE

(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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

REGIONAL MASS TRAINING OF TEACHERS 9/3/2007 9/24/2007 DEPED-REG

176

DIVISION-LED LEARNING ACTION CELL SESSION 1/26/2018 03/16/2018 24 DEPED-GING

DIVISION INSET 04/26/2017 04/28/2017 20.0 DEPED-GING

JUNIOR HIGH SCHOOL TEACHERS TEACHING SENIOR HIGH SCHOOL 6/24/2016 6/26/2016 20.0 DEPED-GING
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

CARPENTRY COOPERATIVE PARENT S.Y 2015-2016/2016-2017/2017-2018

DRAWING

TULA/BALAK KN

CHESS

BASKETBALL

COMPUTER LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPED-REGION X

DEPED-GINGOOG CITY DIVISION

DEPED-GINGOOG CITY DIVISION

DEPED-GINGOOG CITY DIVISION

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

MTAP

MSP

KNIGHTS OF COLUMBUS

eparate sheet if necessary)

September 12, 2019

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
3.5 cm. X 4.5 cm
EDWIN J. EVANGELISTA SAN LUIS NATIONAL HIGH SCHOOL (passport size)

With full and handwritten

LORNA S. LICAYAN DEPED-GINGOOG CITY name tag and signature over
printed name
MALA EFRA B. MAGNAONG LRMDS REGION X Computer generated
or photocopied picture
42. 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 (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: PRC

ID/License/Passport No.: 623415522

Signature (Sign inside the box)
September 12, 2019
Date/Place of Issuance: 7-25-18/PRC REGION X
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