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 AGAD
NAME EXTENSION (JR., SR)
FIRST NAME MAY SHIELA

MIDDLE NAME SULIMA

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

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

please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS SAYAK, DEL CARMEN, SURIGAO DEL NORTE

6 CIVIL STATUS
House/Block/Lot No. Street

Subdivision/Village Barangay

7. HEIGHT (m) 5'0

City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 8418
18. PERMANENT ADDRESS SAYAK, DEL CARMEN, SURIGAO DEL NORTE
9. BLOOD TYPE A
House/Block/Lot No. Street

10. GSIS ID NO. None

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121150612779

City/Municipality Province
12. PHILHEALTH NO. 182005826773 ZIP CODE

13. SSS NO. 0816597901 19. TELEPHONE NO. NONE

14. TIN NO. 20. MOBILE NO. 09308024600

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) maysheilasulima@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME AGAD 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME IAN JAY 4/30/1983

MIDDLE NAME TUMANDA / /

OCCUPATION SELF- EMPLOYED / /

EMPLOYER/BUSINESS NAME NONE / /

BUSINESS ADDRESS NONE / /

TELEPHONE NO. 09285452286 / /

24. FATHER'S SURNAME SULIMA 3/27/1960

NAME EXTENSION (JR., SR)
FIRST NAME ROGELIO / /

MIDDLE NAME BOTONA / /

25. MOTHER'S MAIDEN NAME / /

SURNAME ABAPO 5/31/1958

FIRST NAME MARCELEDES / /

MIDDLE NAME LIBOOC (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not RECEIVED
From To
graduated)
Valedictoria
ELEMENTARY SAYAK ELEMENTARY SCHOOL 6/20/1905 Graduated 1992 1998 With
n
VOCATIONAL / SURIGAO STATE COLLEGE OF Honors/
SECONDARY 6/24/1905 Graduated 1998 2002
TECHNOLOGY- DELCARMEN CAMPUS DCSNWA
Scholorship

SURIGAO STATE COLLEGE OF BACHELOR OF SCIENCE IN INDUSTRIAL Leadership

COLLEGE TRADE 6/28/1905 45 UNITS 2002
Graduated 2006
COURSE TECHNOLOGY- DELCARMEN CAMPUS EDUCATION award
and
GRADUATE STUDIES ST. PAUL UNIVERSITY SURIGAO MA in EDUCATIONAL MANAGEMENT Comprehens 2012 Present
ive exam-
(Continue on separate sheet if necessary) pass
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
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHER 0.8 3/1/2012 CEBU CITY 1141677

(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
(mm/dd/yyyy) MONTHLY PAY GRADE (if
(Write in full/Do (Write SALARY applicable)& STEP STATUS OF APPOINTMENT
(Format "00-0")/
not abbreviate) in full/Do not abbreviate) INCREMENT
From To

6/1/2018 PRESENT TEACHER MT. CARMEL SCHOOL OF SIARGAO 13500.00 PERMANENT

6/1/2015 5/30/2018 SCHOOL IN CHARGE MT. CARMEL SCHOOL OF SIARGAO 13000.00 PERMANENT

6/1/2012 5/30/2015 TEACHER MT. CARMEL SCHOOL OF SIARGAO 12000.00 PROBATIONARY

5/1/2019 3/15/2012 CUSTOMER SERVICE AGENT CEBU PACIFIC AIR-SIARGAO 8000.00 CONRACUAL

6/1/2006 3/30/2009 PRESCHOOLER AGENT SACRED HEART SCHOOL 3000.00 PROBATIONARY

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017)
 LICENSE (if applicable)

Date of
Validity

7/26/2012

on separate sheet if necessary)

GOV'T SERVICE

(Y/
N)

on separate sheet if necessary)

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 / NA
From To

PARISH WESTYV 12/1/2007 PRESENT PARISH LECTOR

PARISH FORMATION TEAM 10/1/2010 PRESENT PARISH FORMATOR

OUR LADY OF MT. CARMEL YOUTH COUNCIL 12/15/2015 PRESENT YOUTH ADVISER

(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
( Managerial/
INTERVENTIONS/TRAINING PROGRAMS (mm/dd/yyyy) NUMBER OF HOURS
Supervisory/
CONDUCTED/ SPONSORED
(Write in full) From To Technical/etc)

TESDA SKILLS LIVELIHOOD TRAINING IN

10/14/2019 11/8/2019 120.0 Del Carmen Municipal Confere
HILOT(MASSAGE) NCII

ENTREPRENEURSHIP TRAINING 11/14/2019 11/15/2019 16.0 Del Carmen Municipal Confere

SIARGAO DIVISION SCHOOLS PRESS CONFERENCE 10/7/2019 10/9/2019 24.0 Sta. Monica, Surigao del Norte

SYMPOSIUM ON BASIC RESEARCH 9/26/2019 9/26/2019 8.0 Mt. Carmel School of Siargao

DISTRICT JOURNALISM TRAINING 9/18/2019 9/20/2019 24.0 Numiancia Central Elementary

2019 SUMMER INSET FOR SENIOR HIGH SCHOOL

4/26/2019 4/28/2019 24.0 Lourdes College, Cagayan De
TEACHER

2019 SUMMER INSET FOR JUNIOR HIGH SCHOOL

4/22/2019 4/24/2019 24.0 Lourdes College, Cagayan De
TEACHER
DISASTER RISK REDUCTION MANAGEMENT (DRRM)
4/9/2019 4/10/2019 16.0 Pastoral Center, Surigao City/
SEMINAR-WORKSHOP

CLASSROOM MANAGEMENT, TEACHING METHODS

7/21/2018 7/21/2018 8.0 San Nicolas School, Bacuag, S
and STRATEGIES SEMINAR

3-DAY IN DIOCESAN SCHOOL SYSTEM IN SERVICE

5/3/2018 5/5/2018 24.0 Saint john's School, Bacuag,Su
TRAINING

2018 SUMMER DepEd-PEAC INSET for SENIOR HIGH

4/27/2018 4/29/2018 24.0 Father Saturnino Urios Univers
SCHOOL TEACHERS IN PRIVATE SCHOOL

DepEd-PEAC's INSTITUTE FOR PRIVATE JUNIOR

3/5/2018 3/7/2018 24.0 University of San Jose - Recole
HIGH SCHOOL ADMINISTRATOR

DepEd PEAC's EXECUTIVE COURSE for EDUCATION

3/1/2018 3/3/2018 24.0 University of San Jose - Recole
LEADER (EXCEL) IN SENIOR HIGH

REGIONAL EDUCATION SUMMIT FOR PRIVATE SCHOOLS 12/12/2017 12/12/2017 8.0 Big Daddy Hotel and Conventio

DIVISION MATHEMATICS FESTIVAL 2017 10/30/2017 10/30/2017 8.0 Gen. Luna Nat'l High School, G

2017 DepEd-PEAC SUMMER INSET FOR SENIOR HIGH

6/2/2017 6/4/2017 24.0 Father Saturnino Urios Univers
SCHOOL TEACHERS
2017 DepEd-PEAC SUMMER INSET FOR JUNIOR
5/29/2017 5/31/2017 24.0 Father Saturnino Urios Univers
HIGH SCHOOL TEACHERS

DepEd-PEAC's INSET ON IMPLEMENTING ON LIFE

CAREER DEVELOPMENT PROGRAM FOR BASIC 11/3/2016 11/5/2016 24.0 Lourdes College, Cagayan De
EDUCATION SCHOOLS

SEMINAR WORKSHOP ON CERTIFICATION

624/2016 6/24/2016 8.0 Father Saturnino Urios Univers
ASSESSMENT FOR PRIVATE SCHHOLS IN CARAGA

SKILLS ENHANCEMENT TRAINING FOR TEACHERS 5/30/2016 6/1/2016 24.0 Pastoral Center, Surigao City

ORIENTATIO ON GUIDELINES ON THE

IMPLEMENTATION ON SHS VOUCHER PROGRAM- 4/28/2016 4/29/2016 16.0 Father Saturnino Urios Univers
GASTPE GUIDELINES

TECHING SCIENCE THROUGH INTERACTIVE

2/26/2016 2/27/2016 16.0 Del Carmen Municipal Confere
APPROACHES: HIGH SCHOOL SCIENCE TEACHERS

2015 PHILIPPINE EDUCATION CONFERENCE AND

12/2/2015 12/3/2015 16.0 SMX Convention Center, Pasa
EXPO

DIVISION ORIENTATION ON THE NCAE and PEPT 9/21/2015 9/21/2015 4.0 Division Office Conference Hal
 2015 SIARGAO DIVISION SCHOOL PRESS
8/30/2015 9/1/2015 24.0 Sta. Monica, Surigao del Norte
CONFERENCE
2015 TRAINING FOR SENIOTR HIGH SCHOOL
5/27/2015 5/28/2015 16.0 Father Saturnino Urios Univers
TEACHERS IN PRIVATE SCHOOL
MEDIA LITERACY EDUCATION FOR
3/17/2015 3/18/2015 16.0 Pastoral Center, Surigao City/
EVANGILIZATION SEMINAR-WORKSHOP

MANCOM CONFERENCE 11/29/2014 11/29/2014 8.0 San Isidro, Surigao del Norte

EDUCATIONAL LEADERSHIP TRAINING 4/1/2014 4/12/2014 96.0 Phoenix Publishing House, Qu

2014 SUMMER IN-SERVICE TRAINING FOR GRADE 9

4/28/2014 4/30/2014 24.0 Father Saturnino Urios Univers
TEACHERS

EXECUTIVE LEADERSHIP TRAINING FOR

PRINCIPALS AND ADMINISTRATORS OF CEAP- 4/1/2014 2/7/2014 8.0 Father Saturnino Urios Univers
CARAGA MEMBER-SCHOOLS

IN-SERVICE TRAINING FOR ESC SCHOOL

4/28/2014 1/24/2014 24.0 Father Saturnino Urios Univers
ADMINISTRATORS 2014
2012 SIARGAO DIVISION TRAINING ON
2/7/2014 10/7/2012 24.0 DTTC, Dapa, Surigao del Norte
COLLABORATIVE DESKTOP PUBLISHING

STORY TELLING WORKSHOP 1/22/2014 8/19/2012 8.0 Del Carmen Municipal Confere

REGIONAL TRAINING FOR GRADE 7 MAPEH

10/5/2012 6/1/2012 32.0 St. Paul University Surigao, Su
TEACHERS OF THE K to 12 CURRICULUM
REGIONAL TRAINING FOR GRADE 7 MAPEH
5/14/2012 5/18/2012 32.0 St. Paul University Surigao, Su
TEACHERS OF THE K to 12 CURRICULUM

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

COOKING

PLAYING TABLE TENNIS

DANCING

PUBLIC SPEAKING

(Continue on separate sheet if necessary)

SIGNATURE DATE
VERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

PARISH LECTOR

PARISH FORMATOR

YOUTH ADVISER

(Continue on separate sheet if necessary)

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

CONDUCTED/ SPONSORED BY (Write in full)

Del Carmen Municipal Conference Hall/ Local Government Unit

Del Carmen Municipal Conference Hall/ Local Government Unit

Sta. Monica, Surigao del Norte/ DepEd Siargao

Mt. Carmel School of Siargao

Numiancia Central Elementary School

Lourdes College, Cagayan De Oro City/ DepEd-PEAC

Lourdes College, Cagayan De Oro City/ DepEd-PEAC

Pastoral Center, Surigao City/ Surigao Diocesan School System

San Nicolas School, Bacuag, Surigao del Norte

Saint john's School, Bacuag,Surigao del Norte/ SDSS

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

University of San Jose - Recoletos, Cebu City/ DepEd-PEAC

University of San Jose - Recoletos, Cebu City/ DepEd-PEAC

Big Daddy Hotel and Convention Center, Butuan City

Gen. Luna Nat'l High School, Gen. Luna Surigao del Norte

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Lourdes College, Cagayan De Oro City/ DepEd-PEAC

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Pastoral Center, Surigao City

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Del Carmen Municipal Conference Hall/ Local Government Unit

SMX Convention Center, Pasay City/DepEd-PEAC

Division Office Conference Hall

 Sta. Monica, Surigao del Norte/ DepEd Siargao

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Pastoral Center, Surigao City/ Surigao Diocesan School System

San Isidro, Surigao del Norte

Phoenix Publishing House, Quezon City/Phoenix Publishing Company

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

Father Saturnino Urios University, Butuan City/ DepEd-PEAC

DTTC, Dapa, Surigao del Norte/ DepEd Siargao

Del Carmen Municipal Conference Hall/ Insular Foundation

St. Paul University Surigao, Surigao City/ DepEd

St. Paul University Surigao, Surigao City/ DepEd

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

(Continue on separate sheet if necessary)

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 If YES, give details:
phased 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
a.
items:
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
(passport size)

With full and handwritten

name tag and signature over
printed name

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 PHOTO
filing of 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 of 4