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

I. PERSONAL INFORMATION
2. SURNAME LABANDERA
FIRST NAME ANALIE NAME EXTENSION (JR., SR)

MIDDLE NAME HINAMPAS

3. DATE OF BIRTH
(mm/dd/yyyy) 09/02/1988 16. CITIZENSHIP

4. PLACE OF BIRTH TAMBONGAN,CANDIJAY,BOHOL If holder of dual citizenship, Pls. indicate country:

please indicate the details.
5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS PARKINGAN
House/Block/Lot No. Street
TAMBONGAN
Subdivision/Village Barangay

7. HEIGHT (m) 1.5 CANDIJAY BOHOL

City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 6312
9. BLOOD TYPE A+
18. PERMANENT ADDRESS PARKINGAN
House/Block/Lot No. Street

10. GSIS ID NO. 0200-4133411 TAMBONGAN

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 0767-7084-6909 CANDIJAY BOHOL

City/Municipality Province
12. PHILHEALTH NO. 12-050884575 ZIP CODE 6312
13. SSS NO. 628945592 19. TELEPHONE NO. N/A

14. TIN NO. 413-201-963 20. MOBILE NO. 09076385703

15. AGENCY EMPLOYEE NO. 4557670 21. E-MAIL ADDRESS (if any) hinampasanalieg@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME LABANDERA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME JUNREY CHARLES H. LABANDERA 12/21/2012

MIDDLE NAME AMOMAS CLARK H. LABANDERA 04/26/2015

OCCUPATION FARMING
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME HINAMPAS

FIRST NAME RENARIO SR

MIDDLE NAME RODRIGUEZ
25. MOTHER'S MAIDEN NAME
SURNAME GULE
FIRST NAME DESIDERIA

MIDDLE NAME JOTOJOT (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

FIRST
ELEMENTARY TAMBONGAN ELEMENTARY SCHOOL PRIMARY EDUCATION 1995 2001 GRADUATED 2001
HONOR
THIRD
SECONDARY /
VOCATIONAL SAINT JOSEPH ACADEMY HIGH SCHOOL 2001 2005 GRADUATED 2005 HONORABLE
MENTION

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

TRADE CENTRAL VISAYAS STATE COLLEGE OF
BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE AGRICULTURE,FORESTRY AND TECHNOLOGY-
MAJOR IN MATHEMATICS
2005 2009 GRADUATED 2009 N/A
TAGBILARAN CITY CAMPUS

SUMMA
GRADUATE STUDIES BOHOL ISLAND STATE UNIVERSITY MASTER OF SCIENCE IN MATHEMATICS 2010 2016 GRADUATED 2016
CUM LAUDE
(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 21,2018

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

CAREER SERVICE PROFESSIONAL 80.24% 07/27/2008 TAGBILARAN CITY 05-019882 N/A

LICENSURE EXAMINATION FOR TEACHERS 80.80% 10/04/2009 CEBU CITY 1044545 09/02/2021

(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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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/ N)

1/1/2017 PRESENT SECONDARY SCHOOL TEACHER II TAMBONGAN NATIONAL HIGH SCHOOL P 21,387 12-1 PERMANENT YES

12/28/2016 12/31/2016 SECONDARY SCHOOL TEACHER II TAMBONGAN NATIONAL HIGH SCHOOL P 20,651 12-1 PERMANENT YES

01/01/2016 12/27/2016 SECONDARY SCHOOL TEACHER I ANOLING NATIONAL HIGH SCHOOL P 19,286 11-2 PERMANENT YES

09/12/2014 12/31/2015 SECONDARY SCHOOL TEACHER I ANOLING NATIONAL HIGH SCHOOL P 18,735 11-2 PERMANENT YES

06/01/2012 09/11/2014 SECONDARY SCHOOL TEACHER I ANOLING NATIONAL HIGH SCHOOL P 18,549 11-1 PERMANENT YES

09/12/2011 05/31/2012 SECONDARY SCHOOL TEACHER ANOLING NATIONAL HIGH SCHOOL P 17,099 11-1 PERMANENT YES

06/05/2011 09/09/2011 SECONDARY SCHOOL TEACHER I TAMBONGAN NATIONAL HIGH SCHOOL P 3,500 N/A CASUAL YES

06/15/2010 06/15/2011 SECONDARY SCHOOL TEACHER I TAMBONGAN NATIONAL HIGH SCHOOL P 3,500 N/A CASUAL YES

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 21,2018

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 / 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 ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
PROGRAMS (Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
RPMS-PPST ORIENTATION 05/28/2019 05/30/2019
MID YEAR INSET
ACTION RESEARCH
DRRM
RPMS
PPST
CONFERENCE LR
SENIOR HIGH SCHOOL(SHS) MASS TRAINING OF TEACHERS(MTOT)
12/11/2017 12/16/2017 44 TECHNICAL
FOR ACADEMIC TRACK ( CORE & SPECIALIZED SUBJECTS) DEPARTMENT OF EDUCATION
2017 MID-YEAR ASSESSMENT AND IN-SERVICE TRAINING 10/23/2017 10/27/2017 40 TECHNICAL DEPARTMENT OF EDUCATION
SENIOR HIGH SCHOOL(SHS) MASS TRAINING OF TEACHERS(MTOT)
08/21/2017 08/25/2017 40 TECHNICAL
FOR APPLIED SUBJECTS DEPARTMENT OF EDUCATION
TWO-DAY WORKSHOP CONFERENCE ON ACCESS & METADATA
05/30/2017 05/31/2017 8 TECHNICAL
OF OFFLINE & ONLINE LEARNING RESOURCES DEPARTMENT OF EDUCATION
SENIOR HIGH SCHOOL(SHS) MASS TRAINING OF TEACHERS(MTOT)
05/19/2017 05/27/2017 72 TECHNICAL
FOR ACADEMIC TRACK DEPARTMENT OF EDUCATION

TAWAG PAGLAUM 03/04/2017 03/04/2017 4 TECHNICAL DEPARTMENT OF EDUCATION

MORAL VALUES FORMATION SEMINAR "LIVE PURE" 03/09/2017 03/09/2017 4 TECHNICAL DEPARTMENT OF EDUCATION

MIDYEAR ASSESSMENT AND INSET FOR TEACHERS 10/24/2016 10/28/2016 40 TECHNICAL DEPARTMENT OF EDUCATION

CVIF PRE-SERVICE TRAINING WORKKSHOP 06/17/2016 06/17/2016 8 TECHNICAL DEPARTMENT OF EDUCATION

STRATEGIC ENHANCEMENT WORKSHOP FOR ARALING PANLIPUNAN

12/12/2015 12/12/2015 8 TECHNICAL DEPARTMENT OF EDUCATION
TEACHERS

MIDYEAR ASSESSMENT AND INSET FOR TEACHERS 10/26/2015 10/30/2015 40 TECHNICAL DEPARTMENT OF EDUCATION

CHILD PROTECTION POLICY TRAINING 11/14/2014 11/15/2014 16 TECHNICAL DEPARTMENT OF EDUCATION

MIDYEAR ASSESSMENT AND INSET FOR TEACHERS 10/20/2014 10/24/2014 40 TECHNICAL DEPARTMENT OF EDUCATION

K-12 MASS TRAINING FOR GRADE 9 MATHEMATICS TEACHERS 05/17/2014 05/21/2014 40 TECHNICAL DEPARTMENT OF EDUCATION

K-12 MASS TRAINING FOR GRADE 8 MATHEMATICS TEACHERS 05/20/2013 05/24/2013 40 TECHNICAL DEPARTMENT OF EDUCATION

MIDYEAR ASSESSMENT AND INSET FOR TEACHERS 10/22/2012 10/25/2012 32 TECHNICAL DEPARTMENT OF EDUCATION

YEAR-END ASSESSMENT AND INSET ON THE ENHANCEMENT OF DYNAMIC

05/07/2012 05/07/2012 24 TECHNICAL DEPARTMENT OF EDUCATION
LEARNING PROGRAM

MIDYEAR ASSESSMENT AND INSET FOR TEACHERS 10/26/2011 10/29/2011 32 TECHNICAL DEPARTMENT OF EDUCATION

THREE-DAY LIVE OUT DIVISION MASS TRAINING OF SECOND YEAR

05/31/2011 06/02/2011 24 TECHNICAL DEPARTMENT OF EDUCATION
TEACHERS ON 2010 SEC

MIDYEAR ASSESSMENT AND INSET FOR TEACHERS 10/27/2010 10/30/2010 32 TECHNICAL DEPARTMENT OF EDUCATION

(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 in
(Write in full)
full)
MATHEMATICAL SOCIETY OF THE
DRIVING N/A
PHILIPPINES-CEBU CHAPTER

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 21,2018

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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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
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,
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
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
GINA B. CASTAÑARES TAMBONGAN, CANDIJAY,BOHOL 09279514299 (passport size)

With full and handwritten

IMA C. BUTRON POBLACION, ALICIA,BOHOL 09176290568 name tag and signature over
printed name

AGRIPINO MAPUTE,JR. TAMBONGAN, CANDIJAY,BOHOL N/A Computer generated

or photocopied picture
is not acceptable
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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.: 1044545

Signature (Sign inside the box)
February 21,2018
Date/Place of Issuance: 1/4/2010/CEBU 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