Republic of the Philippines

Department of Education
REGION XI
SCHOOLS DIVISION OF DAVAO DEL NORTE

REQUIREMENTS
All requirements must be placed in one WHITE folder (with front cover- Name/School/District) and must
be arranged according to the list below. Please use Paper Fastener on the upper portion of the paper.

Deadline of Submission: October 21, 2021

1 copy - Data Privacy Consent Agreement Form

2 copies- Duly accomplished Form 212 (PDS revised 2017) notarized and updated with
Passport size ID photo w/ name tag, ALL ORIGINAL AND UPDATED (printed in
long sized paper may be handwritten or computerized) ACCOMPLISHED DATE
SHOULD NOT BE LATER THAN MARCH 31, 2021.
2 copies- Work Experience Sheet (printed in long size paper) (downloadable
@ http://ro4.csc.gov.ph/downloads/file/31-pds_wes ) ALL ORIGINAL
2 copies Authenticated copy of PRC ID (All Original – to be processed by the AGENCY)
2 copies Authenticated copy of Report of Rating/Board Rating (1 original, 1 photocopy)
2 copies  - NSO/PSA Birth Certificate (1 original, 1 photocopy)
2 copies - Marriage Contract (for female -1 original, 1 photocopy; for male-1 photocopy)
2 copies Certificate of Performance Rating (all original)
2 copies – CAV Masteral/Doctoral (1 original, 1 photocopy)
2 copies Certified Copy of TOR (1 original, 1 photocopy)
1 copy     - Latest Appointment (Photocopy only)
1 copy    - Latest Payslip (Clear photocopy only)
1 copy- Neuropsychological Exam Result (should be taken within Tagum City only- Authorized by
DOH)
2 copies NBI Clearance (1 original, 1 photocopy)
1 copy Omnibus Sworn Statement

REQUEST FOR PRC ID AUTHENTICATION (Place in separate brown envelope)

 Original PRC ID with signature at the back (should not be expired)

 2 clear photocopies of PRC ID (back to back - long sized paper; no punch holes and line marks)
 2 pcs documentary stamps (if 30-pesos doc stamp); 4 pcs (if brown-color doc stamp)
 1 copy of Filled up Authentication Request Form (use blue or black pen - written in capital letters, no
erasures – Form should be printed in Long sized paper
 Printed copy of confirmed paid online appointment (prc.gov.ph)
We only cater PRC DAVAO appointment
Quantity: 2 pcs only

Note: Kung naka ERF na before pwede na dli magsubmit usab og TOR and CAV

Address: Mankilam,Tagum City, Davao del Norte

Telephone Number: (084) 216 0188
Website:www.depeddavnor.ph|Facebook: DepEd Davao del
Norte
 Republic of the Philippines
Department of Education
REGION XI
SCHOOLS DIVISION OF DAVAO DEL NORTE

REMINDERS IN FILLING OUT THE WORK EXPERIENCE SHEET

 Delete the “Sample: If applying to Supervising Administrative Officer” before filling up the form.
 Work experience should be listed from most recent first.  
 The duration should include start and finish dates, if known, month and year in full. For the current position, use the word
Present, e.g., 1998-Present.
 The DATE should be the same with the accomplished date of your PDS.
 Duration and Position Title should be the same with what is indicated on PDS page 2.
REMINDERS IN FILLING OUT THE PERSONAL DATA SHEET (PDS) - CSC form 212 Revised 2017
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.

 The PDS must bear the signature of the employee and date of accomplishment at the bottom of every page.
 All information should be provided accurately.
 Do not leave blank entries. Put N/A if not applicable.
 Double checked the DATE and PLACE of Birth based on what is stated on your Birth Certificate
 Dates are in numeric format: mm/dd/yyyy
 Mother’s name is her maiden name, or name when she was single or before marriage.
Educational Background
 Indicate FULL name of schools. DO NOT ABBREVIATE.
 For Elementary Level, indicate ELEMENTARY
 For Secondary Level, indicate HIGH SCHOOL
 Indicate in FULL all courses taken in college (e.g. Bachelor of Secondary Education major in Biological Science).
 Indicate all masters or doctorate degrees taken. Insert additional rows if needed.
 If graduated for every level, indicate GRADUATED in Highest Level/Units Earned column if not graduated indicate level or
number of units earned.
Civil Service Eligibility
 Indicate all civil service eligibilities earned with corresponding rating, Date, specific place of examination/conferment, license
number and its date of validity.
Work Experience
 Indicate all positions held both in the public and private employment starting from current work.
 Inclusive dates are indicated in numeric format: mm/dd/yyyy.
 Indicate FULL position titles and COMPLETE NAME of department/agency/office/company. DO NOT ABBREVIATE.
 Indicate monthly salary in figures (e.g. P21,877).
 Salary grade and salary step, if applicable, should be stated in the format ”00-0” (e.g. 24-2, 24 for salary grade, 2 for salary
step)
 Indicate status of employment (e.g. permanent, temporary, casual, contractual)
 Indicate “Yes” under government service if position held is in the public or government employment or “No” if held in the
private employment.
Learning and Development Interventions
 Indicate FULL titles of learning and development (L&D) interventions attended during employment. Indicate list from the most
recent L&D.
 Inclusive dates of attendance, start (from) and end (to) should be in numeric format: mm/dd/yyyy.
 Indicate the number of hours attended for program.
 Indicate the type of L&D intervention (e.g. managerial, supervisory,technical).
 Indicate the FULL name of institution/agency that conducted orsponsored the program. DO NOT ABBREVIATE. (e.g. CSC
should be Civil Service Commission).
# 34-40
 Indicate response to questions 34 to 40 on the right side of the sheet.
 Provide details or specifications for any yes response.
# 41
 Indicate the FULL name of references with the format FIRST NAME, MI,SURNAME, their addresses and respective telephone
numbers.
# 42
 As agreement to and for completion of the PDS, the employee’s signature and right thumb mark should be affixed in the boxes
provided. Indicate also the government ID number and date of issuance in the boxes provided. Lastly,attached a RECENT
PASSPORT SIZE (4.5 cm. x 3.5 cm.) picture with COMPLETE AND HANDWRITTEN NAME TAG and SIGNATURE OVER PRINTED
NAME. Picture must be taken within the last six (6) months. Computer generated or photocopied picture is not acceptable.

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Address: Mankilam,Tagum City, Davao del Norte
Telephone Number: (084) 216 0188
Website:www.depeddavnor.ph|Facebook: DepEd Davao del Norte