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 AQUINO
NAME EXTENSION (JR., SR)
FIRST NAME KEVIN

MIDDLE NAME PANGUISA

3. DATE OF BIRTH
9/5/1994 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH DACLAN, BOKOD, BENGUET If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
✘ Male
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS Single ✘ Married
House/Block/Lot No. Street
Widowed
Separated Namnama B Belance
Other/s:
Subdivision/Village Barangay
Dupax del Norte Nueva Vizcaya
7. HEIGHT (m) 1.65
City/Municipality Province
8. WEIGHT (kg) 63 ZIP CODE 3706

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
Baysi Castillo Village
10. GSIS ID NO. 02005014491
Subdivision/Village Barangay
Kayapa Nueva Vizcaya
11. PAG-IBIG ID NO. 121180172027
City/Municipality Province

12. PHILHEALTH NO. 06-251205197-4 ZIP CODE 3708

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 488 -552 -548 20. MOBILE NO. 09123699435

15. AGENCY EMPLOYEE NO. 5268843 21. E-MAIL ADDRESS (if any) kevin.aquino@deped.gov.ph / kevinpanquisaaquino@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME AQUINO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) Izaiah Khervin W. Aquino
FIRST NAME CHARMANNE 6/12/2021

MIDDLE NAME WAYAN

OCCUPATION Teaching

EMPLOYER/BUSINESS NAME DEPARTMENT OF EDUCATION

BUSINESS ADDRESS BAYOMBONG, NUEVA VIZCAYA

TELEPHONE NO. N/A

24. FATHER'S SURNAME AQUINO

NAME EXTENSION (JR., SR) SR
FIRST NAME ANTHONY

MIDDLE NAME GAON

25. MOTHER'S MAIDEN NAME

SURNAME PANGUISA

FIRST NAME ISABEL

MIDDLE NAME MENZI (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY AMBANGEG ELEMENTARY SCHOOL ELEMENTARY 6/12/2001 3/29/2006 N/A 2006

FIRST HON.
SECONDARY /
VOCATIONAL BENGUET STATE UNIVERSITY -BOKOD CAMPUS SECONDARY 6/5/2006 3/28/2010 N/A 2010
MENTION

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

TRADE
NUEVA VIZCAYA STATE UNIVERSITY - BAMBANG BACHELOR IN SECONDARY EDUCATION -
COURSE
COLLEGE
CAMPUS PHYSICAL SCIENCE
6/14/2010 4/14/2015 N/A 2015 CUM LAUDE

MASTER OF ARTS IN TEACHING (PHYSICAL Academic

GRADUATE STUDIES IFUGAO STATE UNIVERSITY 8/6/2018 Pressent N/A
SCIENCE) Completion
 (Continue on separate sheet if necessary)

SIGNATURE DATE JULY 07, 2022

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

LICENSURE EXAMINATION FOR TEACHERS 78.0 8/25/2016 BAGUIO CITY 1477354 9/5/2022

(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)

1/10/2022 TO DATE TEACHER 1 -Bugkalot HS DEPED - BUGKALOT HIGH SCHOOL 25723.00 11-2 PERMANENT Y

1/1/2017 09/31/2021 TEACHER 1- Kayapa HS DEPED- KAYAPA HIGH SCHOOL 24161.00 11-2 PERMANENT Y
CONTRACTUA
06/13/16 12/31/2016 TEACHER 1 DEPED- KAYAPA HIGH SCHOOL 19520.00 11-1 Y
L

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 07, 2022
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

Keys of the Kingdom Ministries -Life in Spirit Fellowship 11/6/2012 Present N/A Member

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

Project Work In Progress 04/26/2022 04/29/2022 Instructional Bugkalot High School

Project Ripples 2.0 9/2/2022 11/2/2022 24.0 Instructional DepEd- SDO Nueva Vizcaya

Alternative Learning Materials Cum Mental Health and Psychological Support Services Mid-Yead
01/31/2022 4/2/2022 32.0 Instructional DepEd-Bugkalot High School
Inset

National Science Club Month Webinar Series 4/9/2021 09/25/2021 32.0 Instructional DepEd- Central Office

Science Research Optimizing Digital Strategies: Mechanism to the New Normal 07/14/2020 07/20/2020 40.0 Technical DepEd Division of Nueva Vizcaya

Conducting Modular Distance Classes for SHS Learner 07/13/2020 07/13/2020 8.0 Instructional Vibal Group. Inc.

Developing Learning Materials for SHS - Humanities and Social Science Track Courses 9/7/2020 9/7/2020 8.0 Instructional Vibal Group. Inc.

Strengthening the Growth Mindset in the Midst of the Pandemic: The key to Lifelong Learning in
8/7/2020 8/7/2020 8.0 Instructional Vibal Group. Inc.
SHS

SHS in the New Normal:Trends in Conducting Classes and Administrative Operations 7/7/2020 7/7/2020 8.0 Instructional Vibal Group. Inc.

How Professional Learning Communities Impact Students' Success 6/7/2020 6/7/2020 8.0 Instructional Vibal Group. Inc.

Designing Supplementary Reading Materials Based on Constructivist Approach 3/7/2020 3/7/2020 8.0 Instructional Vibal Group. Inc.

"Innovations in Teaching and Learning: Utilizing Electronic Teaching Materials

06/29/2020 06/29/2020 8.0 Instructional Vibal Group. Inc.
in Virtual Classes"
Lewis Theory (Learning strategies for teachers and
4/7/2020 4/7/2020 8.0 Technical Filipino Science Hub
students)

4.0 Regional Basic Education Research Conference 5/12/2018 7/12/2018 24.0 Technical DepEd Region 02

Occupational First Aid & Cardipulmonary Resuscitation with AED Training 9/8/2018 12/8/2018 32.0 Technical DepEd Division of Nueva Vizcaya

Cluster Based Mid Year Assessment and INSET 2018 10/22/18 10/26/2018 40.0 Instructional DepEd Western District of Kayapa

School Based Roll-out on the Result of Performance Management System Manual for Teacher
06/20/2018 06/31/2018 24.0 Instructional DepEd Kayapa High School
and School Heads

School Based Mid Year Assessment and Inset 2017 10/23/17 10/27/17 40.0 Technical DepEd Kayapa High School

Senior High School (SHS) Mass Training of Teacher on Common Topics 09/15/17 09/17/17 32.0 Technical DepEd Region 02

Basic First Aid Training Course 09/13/17 09/14/17 17.0 Instructional MDRRMO Kayapa, Nueva Vizcaya

Seminar Workshop on Qualitative Research and Action Research Writing for Senior High School
09/21/2017 09/23/2017 24.0 Instructional DepEd Division of Nueva Vizcaya
Teachers
(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)

Computer MS Skills Most Outstanding Teacher (2021) - Western Kayapa District KKM-LSFI

Coordinating and Organizing Activities Most Outstanding Science Teacher (1st Runner Up) 2020 - Western Kayapa District Bokod Suphur Spring Multi-Purpose Cooperative

Reading Most Outstanding DRRM Coordinator - Western Kayapa District

Computer Lay-out and Design Most Outstanding Physical Science Teacher (2019) - Western Kayapa District

Research Writing Outstanding Performance Rating - Western Kayapa District

Best in IPCRF Portfolio - Western Kayapa District

 (Continue on separate sheet if necessary)

SIGNATURE DATE JULY 07, 2022

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
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? ________________________________
________________________________
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: Kalanguya/Ibaloi
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
ARNEL M. BATALLA ARITAO, NUEVA VIZCAYA 9998225177 3.5 cm. X 4.5 cm
(passport size)

RODELIO B. DELA CRUZ BAYOMBONG, NUEVA VIZCAYA N/A With full and handwritten
name tag and signature over
printed name
ROMY C. DAGA KAYAPA, NUEVA VIZCAYA 9479659851
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 LICENSE

ID/License/Passport No.: 1477354

Signature (Sign inside the box)
Date/Place of Issuance: 11/23/2016 / Baguio 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