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

MIDDLE NAME MARTIN

3. DATE OF BIRTH
9/30/1996 16. CITIZENSHIP Dualby by
(mm/dd/yyyy) ✘ Filipino
Citizenship
birt naturaliz
4. PLACE OF BIRTH T'BOLI SOUTH COTABATO If holder of dual citizenship,
h
Pls. indicate country:
ation
please indicate the details.
5. SEX ✘ Male Fem
6 CIVIL STATUS ✘ ale
Marri 17. RESIDENTIAL ADDRESS LANZONES
Single
Wido Sepa House/Block/Lot No. Street
ed CHANGCO 1-A BAWING/SIGUEL
Other
wed rated Subdivision/Village Barangay
7. HEIGHT (m) /s: 1.65 GENERAL SANTOS CITY SOUTH COTABATO
City/Municipality Province
8. WEIGHT (kg) 59 ZIP CODE 9500
18. PERMANENT ADDRESS LANZONES
9. BLOOD TYPE AB
House/Block/Lot No. Street
CHANGCO 1-A BAWING/SIGUEL
10. GSIS ID NO.
Subdivision/Village Barangay
GENERAL SANTOS CITY SOUTH COTABATO
11. PAG-IBIG ID NO. 121141163675
City/Municipality Province
12. PHILHEALTH NO. 170503461148 ZIP CODE 9500
13. SSS NO. 0937409075 19. TELEPHONE NO.

14. TIN NO. 466-505-365 20. MOBILE NO. 0956-032-3926

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) martinbulawan30@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME BULAWAN

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

MIDDLE NAME SENO

25. MOTHER'S MAIDEN NAME

SURNAME MARTIN

FIRST NAME DELILAH

MIDDLE NAME LAWA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL LEVEL/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS SCHOLARSHIP/ ACADEMIC
LEVEL EARNED
GRADUATED
HONORS RECEIVED
(Write in full)
(Write in full) (if not
From To
graduated)
ELEMENTARY BAWING ELEMENTARY SCHOOL ELEMENTARY 6/4/2005 3/30/2010 2010 WITH HONORS
VOCATIONAL /
SECONDARY BAWING NATIONAL HIGH SCHOOL HIGH SCHOOL 6/6/2010 3/26/2014 2014 8TH HONORS
1st INTERNATIONAL COMPUTER
TECHNOLOGY COLLEGES, INC.
BASIC COMPUTER LITERACY 12/1/2021 12/10/2021 2021 N/A
TRADE
COURSE HOLY TRINITY COLLEGE OF GENERAL BACHELOR OF PHYSICAL EDUCATION MAJOR IN
COLLEGE
SANTOS CITY SCHOOL P.E
6/11/2014 3/28/2019 2019 N/A

GRADUATE STUDIES 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

LISCENSURE EXAM FOR TEACHERS 76.0 9/26/2021 KORONADAL CITY

(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/ SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
GENERAL SANTOS CITY NATIONAL HIGH
11/27/2018 MARCH PRACTICE TEACHING
SCHOOL

(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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE
From To

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

PAFTE REGION 12 TEACHER'S CONGRESS 2018 3/9/2018 3/9/2018 8.0 TECHNICAL PHILIPPINE ASSOCIATION FO

SDG TALK ON GLOBAL CITIZENSHIP EDUCATION 12/9/2017 12/9/2017 8.0 TECHNICAL YOUNG EDUCATORS CONV

SDG TALK ON GENDER EDUCATION 12/9/2017 12/9/2017 8.0 TECHNICAL YOUNG EDUCATORS CONV
COMBATIVE SPORTS TRAINING (BASIC SELF
1/19/2018 1/19/2018 8.0 TECHNICAL HOLY TRINITY COLLG
DEFENSE)
BASIC COMPUTER LITERACY 12/1/2021 12/10/2021 80 TECHNICAL 1ST INTERNATIONAL COMPU

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A PHYSICAL EDUCA

DANCING YOUNG ED

SINGING NATIONAL COMMISSION

CHOREOGRAPHER

(Continue on separate sheet if necessary)

SIGNATURE DATE
ON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

(Continue on separate sheet if necessary)

IONS/TRAINING PROGRAMS ATTENDED
&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY (Write in full)

PHILIPPINE ASSOCIATION FOR TEACHERS EUDCATORS REGION 12

YOUNG EDUCATORS CONVERGENCE OF SOCCSKSARGEN,INC

YOUNG EDUCATORS CONVERGENCE OF SOCCSKSARGEN,INC

HOLY TRINITY COLLGE OF GENERAL SANTOS CITY

1ST INTERNATIONAL COMPUTER TECHNOLOGY COLLEGES. INC

(Continue on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

PHYSICAL EDUCATORS GUILD OF GENSAN

YOUNG EDUCATOR SOCIETY

NATIONAL COMMISSION ON INDIGENOUS PEOPLE (NCIP)

(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? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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
YES ✘ NO
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, YES ✘ NO
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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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: BLAAN
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
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: PRC

ID/License/Passport No.:
Signature (Sign inside the box)
FEBRUARY
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