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 ESCLANDA
NAME EXTENSION (JR., SR)
FIRST NAME MARIA CARMELA RACHEL

MIDDLE NAME GAZIL

3. DATE OF BIRTH
(mm/dd/yyyy) DECEMBER 09, 1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH LUCENA CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS N/A SAMPAGUITA

Widowed Separate House/Block/Lot No. Street
Other/s: SITIO PILAWAY POLO
d
Subdivision/Village Barangay
MAUBAN QUEZON
7. HEIGHT (m) 1.2
City/Municipality Province
8. WEIGHT (kg) 65 ZIP CODE 4330

18. PERMANENT ADDRESS SAMPAGUITA

9. BLOOD TYPE O+
House/Block/Lot No. Street
SITIO PILAWAY POLO
10. GSIS ID NO. 2005095104
Subdivision/Village Barangay
MAUBAN QUEZON
11. PAG-IBIG ID NO. 1210-0599-7411
City/Municipality Province

12. PHILHEALTH NO. 08-025385369 ZIP CODE 4330

13. SSS NO. 04-2404795-3 19. TELEPHONE NO. 042-717-0471

14. TIN NO. 327-799-132 20. MOBILE NO. 09122772058

15. AGENCY EMPLOYEE NO. 5497841 21. E-MAIL ADDRESS (if any) gazilmela@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ESCLANDA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME ROGELIO N/A MARK LORENZO G. ESCLANDA 09/28/2011

MIDDLE NAME BORI ALEX ZENO G. ESCLANDA 05/20/2017

OCCUPATION MECHANICAL ENGINEER (HVAC SUPERVISOR)

EMPLOYER/BUSINESS NAME APO PHILTRADE AND TRADING SERVICES INC.

BUSINESS ADDRESS MAUBAN, QUEZON

TELEPHONE NO. 9129198062

24. FATHER'S SURNAME GAZIL

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

MIDDLE NAME BANTAYAN

25. MOTHER'S MAIDEN NAME

SURNAME CABUYAO

FIRST NAME VIRGINIA

MIDDLE NAME PADUA (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 GRADUATED
(Write in full) EARNED HONORS
full) (if not graduated) RECEIVED
From To

10TH
ELEMENTARY MOTHER PERPETUA PAROCHIAL SCHOOL PRIMARY EDUCATION 1999 2005 N/A 2005
HONOR

SECONDARY /
VOCATIONAL MOTHER PERPETUA PAROCHIAL SCHOOL SECONDARY SCHOOL 2005 2009 N/A 2009 6TH HONOR

BALAY-BALAY LEARNING CENTER BAKING AND PASTRY PRODUCTION 2015 2015 N/A 2015 N/A
TRADE
BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE PAMBAYANG KOLEHIYO NG MAUBAN
MAJOR IN ENGLISH
2011 2015 N/A 2015 N/A

GRADUATE STUDIES SACRED HEART COLLEGE MASTER OF ARTS IN ENGLISH 2016 2019 N/A 2019 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 20, 2020

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

LET (LICENSURE EXAMINATION FOR TEACHERS) 77.8 09/27/2015 SACRED HEART COLLEGE, LUCENA CITY 1412360 9/12/2022

(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)

1/9/2016 Present Teacher I DEPERTMENT OF EDUCATION ₱20,754.00 11-1 PERMANENT Y

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 20, 2020

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

ARMY RESERVE COMMAND QUEZON 4/16/2010 PRESENT 80.0 TEAM LEADER

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
INTERNATIONAL SEMINAR-WORKSHOP ON ENGLISH LANGUAGE TEACHING FOR ALL
11/29/2019 1/12/2019 24 TECHNICAL COYEESAN PLAZA HOTEL, BAGUIO CITY
LEVELS
PHILIPIINE INTERNATIONAL CONVENTION CENTER,
2019 CONFERENCE OF BASIC EDUCATION RESEARCHERS 10/29/2019 10/31/2019 24 TECHNICAL
PASAY CITY
ADELA S. TORRES NATIONAL HIGH SCHOOL,
ENGLISH LANGUAGE LEARNING THROUGH READING AND RESEARCH 07/15/2019 07/17/2019 12 TECHNICAL
SAMPALOC, QUEZON
ADELA S. TORRES NATIONAL HIGH SCHOOL,
SAMPALOC DISTRICT PRE-OPENING IN-SERVICE TRAINING FOR TEACHERS 05/31/2019 05/31/2020 8 TECHNICAL
SAMPALOC, QUEZON

ENGLISH LANGUAGE LEARNING THROUGH READING AND RESEARCH 9/6/2018 3/4/2017 7 TECHNICAL SEVILLA'S FARM AND RESORT

CONTINUING IN-SERVICE TRAINING FOR SECONDARY SCHOOL TEACHERS: UPDATING ADELA S. TORRES NATIONAL HIGH SCHOOL,
05/23/2018 05/23/2018 7 TECHNICAL
AND REVISITING EDUCATIONAL CONTENT AND EXTERNAL PARAMETERS SAMPALOC, QUEZON
ECHO SEMINAR ON APPLIED LINGUISTICS AND LANGUAGE TEACHING: RESEARCH,
3/4/2017 3/4/2017 8 TECHNICAL SACRED HEART COLLEGE INC., LUCENA CITY
THEORY, PEDAGOGY AND PRACTICE
SKILL BUILDING SEMINAR IN INFORMATION AND COMMUNICATION TECHNOLOGY FOR SAMPALOC NATIONAL HIGH SCHOOL, SAMPALOC,
10/26/2016 10/28/2016 24 TECHNICAL
EDUCATION (ICT4E) QUEZON
SAMPALOC NATIONAL HIGH SCHOOL, SAMPALOC,
TWO-DAY GAD CONCEPTUAL CLARITY AND ORIENTATION 10/24/2016 10/25/2016 16 TECHNICAL
QUEZON
ICT TRAINING FOR EDUCATORS MS OFFICE APPLICATION (WORD, EXCEL, POWERPOINT
01/16/2016 3/2/2016 80 TECHNICAL E-LEARNINGVILLE MAUBAN, QUEZON
& PUBLISHER), MOVIE MAKER & ADOBE PHOTOSHOP CS6

BAKING AND PASTRY PRODUCTION 05/23/2015 1/6/2015 120 TECHNICAL TESDA

KULTURANG BAYAN 2015 04/27/2015 05/19/2015 80 TECHNICAL MAUBAN TOURISM

CADET OFFICER LEADERSHIP TRAINING 04/16/2015 04/25/2015 80 TECHNICAL DEPED QUEZON

JOINT ROTC SUMMER CAMP TRAINING 04/19/2010 05/23/2010 290 TECHNICAL HEADQUARTERS ARMY RESERVE COMMAND

(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)

BAKING ACADEMIC TESDA

DRAWING NON-ACADEMIC N/A

ICT ACADEMIC N/A

JOURNALISM ACADEMIC N/A

LEADERSHIP SKILLS NON-ACADEMIC N/A

DANCING NON-ACADEMIC N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 20, 2020

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
by any court or tribunal? YES ✘ NO
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
PROF. FE D. NAVA MAUBAN, QUEZON 9479389545 4.5 cm. X 3.5 cm
(passport size)

MRS. MARICAR ABELLA-AGUERRA TAYABAS CITY, QUEZON 9283908930

Computer generated
or photocopied picture
MRS. MARY ANN TORRES MAUBAN, QUEZON 9104880409 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.: 1412360

Signature (Sign inside the box)
FEBRUARY 20, 2020
Date/Place of Issuance: 12/09/2022 - LUCENA CITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 20TH DAY OF FEBRUARY 2020

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

VIOLETA T. CATAPIA
PRINCIPAL II
Person Administering Oath

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