CS Form No.

212
Revised 2017 Applicant No.
PERSONAL DATA SHEET T15172351
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 N (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME REYES

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

MIDDLE NAME ALIM

3. DATE OF BIRTH
(mm/dd/yyyy) 08/23/1991 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH DONSOL, SORSOGON 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 NOGAS ALLEY, PAG-ASA
Widowed Separated House/Block/Lot No. Street
NONE NURSERY
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.65 MASBATE MASBATE
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 5400

9. BLOOD TYPE O+
18. PERMANENT ADDRESS N/A TRES MARIAS DRIVE
House/Block/Lot No. Street

10. GSIS ID NO. BP NO. 2003406788

NONE TRES MARIAS
Subdivision/Village Barangay
DONSOL SORSOGON
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 10225333451117 ZIP CODE 4715

13. SSS NO. N/A 19. TELEPHONE NO. (056)578-2321

14. TIN NO. N/A 20. MOBILE NO. 09778425900 / 09150686188

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) jomarreyes29@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME REYES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH(mm/dd/yyyy)

NAME EXTENSION (JR., SR) CALIX HIENDRICH S. REYES

FIRST NAME KYLIE MAY N/A 11 /20 /2016

MIDDLE NAME SICLOT ARCHIEL ANGELO S. REYES 01/10/2015

OCCUPATION AGRARIAN REFORM OFFICER I (ARPO I) NIKEESHA MIKAELA S. REYES 12/07/2013

EMPLOYER/BUSINESS NAME DEPARTMENT OF AGRARIAN REFORM -MASBATE N/A N/A

BUSINESS ADDRESS ACACIA ROAD, BRGY. NURSERY, MASBATE N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME REYES N/A N/A

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

MIDDLE NAME MERCADO N/A N/A

25. MOTHER'S MAIDEN NAME MARICHU CADAG ALIM N/A N/A

SURNAME REYES N/A N/A

FIRST NAME MARICHU N/A N/A

MIDDLE NAME ALIM (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY DONSOL EAST CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1997 2004 GRADUATED 2004 N/A

DONSOL NATIONAL COMPREHENSIVE

SECONDARY /
VOCATIONAL HIGHSCHOOL HIGH SCHOOL 2004 2008 GRADUATED 2008 N/A

TESDA NC II TECHNICAL
SOUTHERN BICOL COLLEGE 2020 2020 GRADUATED 2020 N/A
DRAFTING
TRADE
BACHELOR OF ELEMENTARY
COURSE
COLLEGE DIVINE WORD COLLEGE OF LEGASPI 2008 2015 GRADUATED 2015 N/A
EDUCATION
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)
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 Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
03/20/2016/ PAG-ASA ELEMENTARY HIGH SCHOOL, RAWIS,
LICENSURE ELEMENTARY FOR TEACHER 76.00% 1450046 08/23/2020
06/08/2016 LEGASPI CITY

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

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

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

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

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

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

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

DEPED MASBATE CITY./ GOVERNOR

10/03/2019 12/28/2019 TEACHER I (SUBSTITUTE) LETADA 20,754.00 11-1 CONTRACT Y
MEMORIAL ELEMENTARY SCHOOL
DEPED MASBATE CITY/ RENE T. MALVAR
09/05/2019 10/2/2019 TEACHER I (SUBSTITUTE) 20,754.01 11-1 CONTRACT Y
ELEMENTARY SCHOOL
DEPED MASBATE CITY/ BIYONG
08/07/2019 9/5/2019 TEACHER I (SUBSTITUTE) 20,754.01 11-1 CONTRACT Y
ELEMENTARY SCHOOL
DEPED MASBATE CITY/ RENE T. MALVAR
07/08/2019 08/07/2019 TEACHER I (SUBSTITUTE) 20,754.01 11-1 CONTRACT Y
ELEMENTARY SCHOOL
ASCEND 2.0 PROGRAM/ DEPED MASBATE
08/13/2018 03/20/2018 VOLUNTEER TEACHER N/A N/A N/A N/A
CITY
NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

NIA N/A NIA NIA N/A N/A N/A NIA

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS (Write in NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
full) Technical/etc)
From To

INFORMATION AND COMM. TECH.

VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 08/30/2021 09/03/2021 40 TECHNICAL SERVICES-EDUCATIONAL TECH. UNIT (ICTS-
EdTech)

DEPARTMENT OF INFORMATION AND

GOOGLE WORKSPACE FOR COMMUNICATION TECHNLOGY LUZON
07/26/2021 07/30/2021 40 TECHNICAL
EDUCATION FUNDAMENTALS VIA ZOOM PLATFORMS CLUSTER-3. ICT LITERACY AND COMPETENCY
DEVELOPMENT BUREAU

SUPER SCHOOL SERIES:BEST PRACTICES OF MOREH ACADEMY 06/26/2020 06/26/2020 2 TECHNICAL VIBAL GROUP

ECUMENISM IN RELIGIOS EDUCATION 06/26/2020 06/26/2020 2 TECHNICAL VIBAL GROUP

DESIGNING INSTRUCTIONAL MATERIALS USING TV

06/26/2020 06/26/2020 4 TECHNICAL VIBAL GROUP
AND RADIO AS PLATFORMS IN TV

EMPOWER STUDENT: LEARNING WITH TEACHER CLARITY 06/25/2020 06/25/2020 4 TECHNICAL VIBAL GROUP

CAPACITATING TEACHERS IN THE USE OF RADIO AND TV IN TEACHING

06/25/2020 06/25/2020 4 TECHNICAL VIBAL GROUP
BASIC EDUCATION

SUPER SCHOOL SERIES: BEST PRACTICES OF NAGA PAROCHIAL

06/24/2020 06/24/2020 2 TECHNICAL VIBAL GROUP
SCHOOL

ASYNCHRONOUS PE AS STUDENT'S HOME LEISURE ACTIVITY FOR

06/24/2020 06/24/2020 2 TECHNICAL VIBAL GROUP
FOR FITNESS AND MENTAL HEALTH

USE OF EDUCATIONAL TELEVISION AD RADIO SHOWS IN TEACHING 06/24/2020 06/24/2020 4 TECHNICAL VIBAL GROUP

SUPER SCHOOL SERIES: BEST PRACTICES OF IPREP PLAY AND LEARN 06/23/2020 06/23/2020 2 TECHNICAL VIBAL GROUP

GUIDING YOUNG LEARNERS TO ONLINE DISTANCE LEARNING 06/23/2020 06/23/2020 4 TECHNICAL VIBAL GROUP

CONCEPTUALIZATION, USE, AND CREATION OF SELF MADE

06/23/2020 06/23/2020 2 TECHNICAL VIBAL GROUP
VIDEOS FOR ONLINE LEARNING

UTILIZING LOCAL AND GOVERNMENT TV AND RADIO BROADCASTING IN

06/22/2020 06/22/2020 4 TECHNICAL VIBAL GROUP
ENHANCING STUDENT'S COMPETENCIES

"GABAY SA KURIKULUM PARA SA MAGULANG: MAHUSAY NA PAGKATUTO

06/22/2020 06/22/2020 2 TECHNICAL VIBAL GROUP
NG ARALING PANLIPUNAN"

EVERYONE'S AN INFLUENCER: TIPS ON PERSONAL BRANDING IN THE

06/22/2020 06/22/2020 2 TECHNICAL VIBAL GROUP
DIGITAL AGE

2 DAY SCHOOL IN SERVICE TRAINING ON ENHANCEMENT DEPED MASBATE CITY/ GOVERNOR LETADA MEMORIAL
10/23/2019 10/24/2019 16 TECHNICAL
OF TEACHER'S COMPETENCE IN TEACHING READING ELEMENTARY SCHOOL

2 DAY SCHOOL IN SERVICE TRAINING ON ICT LITERACY IN TEACHING

DEPED MASBATE CITY/ GOVERNOR LETADA MEMORIAL
LEARNING 10/212019 10/22/2019 16 TECHNICAL
ELEMENTARY SCHOOL
PROCESS AND MANAGING LEARNER'S RECORD

VOLUNTEER DURING BRIGADA ESKELA 2019

05/20/2019 05/25/2019 40 TECHNICAL JOSE ZURBITO SR. ELEMENTARY SCHOOL
" MATATAG NA BAYAN PARA SA MAUNLAD NA PAARALAN"

SEMINAR /WORKSHOP/ TRAINING ON PREPARING ICT-BASED

05/25/2018 05/27/2018 24 TECHNICAL AFHCA PROFESSIONAL DEVELOPMENT CENTER (PDC)
INSTRUCTION AND LEARNING MATERIAL IN THE K-12 CURRICULUM

(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)
TECHNICAL DRAFTING IN
N/A N/A
AUTOCAD
HANDLING MICROSOFT OFFICE N/A N/A
PLAYING BADMINTON N/A N/A

PLAYING BASKETBALL N/A N/A

MANUAL DRAFTING N/A N/A

EDITING PICTURES N/A N/A

PLAYING GUITAR N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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:
________________________________
N/A

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
N/A
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed: N/A
________________________________
Status of Case/s: N/A

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? ________________________________
FINISHED CONTRACT
________________________________

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: N/A
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):
N/A
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: N/A
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No: N/A
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No: N/A

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
SUSAN B. ESPARES BRGY. MALINTA, MASBATE CITY 09217765813 3.5 cm. X 4.5 cm
(passport size)

LOIDA C. VALENZUELA MASBATE CITY 09185310112 With full and handwritten

name tag and signature over
printed name
JEMNAH A. MACABE BRGY. IBINGAY, MASBATE CITY 09215394954
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
Government Issued ID: PRC

ID/License/Passport No.: 1450056

Signature (Sign inside the box)

Date/Place of Issuance: 10/22/2019/ PRC, RAWIS,LEG.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