CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 SANTOS
NAME EXTENSION (JR., SR) N/A
FIRST NAME ANGELINA

MIDDLE NAME SANTOS

3. DATE OF BIRTH
(mm/dd/yyyy) 10/2/1983 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH CALANGAIN, LUBAO, PAMPANGA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
Single ✘ Married 17. RESIDENTIAL ADDRESS #2 PUROK 1 N/A
Widowed Separate House/Block/Lot No. Street
d N/A LOURDES
Other/s:
Subdivision/Village Barangay
LUBAO PAMPANGA
7. HEIGHT (m) 1.58 M
City/Municipality Province
8. WEIGHT (kg) 66 KLS. ZIP CODE 2005

18. PERMANENT ADDRESS #2 PUROK 1 N/A

9. BLOOD TYPE B
House/Block/Lot No. Street
N/A LOURDES
10. GSIS ID NO. 0-200-420-592-4
Subdivision/Village Barangay
LUBAO PAMPANGA
11. PAG-IBIG ID NO. 140-00150-1198
City/Municipality Province

12. PHILHEALTH NO. 07-050470438-4 ZIP CODE 2005

13. SSS NO. 02-2222311-5 19. TELEPHONE NO. N/A

14. TIN NO. 235-472-234 20. MOBILE NO. 09692763102

15. AGENCY EMPLOYEE NO. 4278194 21. E-MAIL ADDRESS (if any) angelina.santos001@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SANTOS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME MELANDRO

NAME EXTENSION (JR., SR) AIDEN MATTHEW S. SANTOS 3/24/2015
N/A

MIDDLE NAME MANGANTI N/A N/A

OCCUPATION OFW N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

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

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

FIRST NAME CONRADO

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

MIDDLE NAME CALMA N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME ISIP N/A N/A

FIRST NAME TEREZA N/A N/A

MIDDLE NAME GAVIOLA (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

3RD HONORABLE
ELEMENTARY STA CRUZ ACADEMY PRIMARY EDUCATION 6/3/1991 3/28/1996 N/A 1996 MENTION

SECONDARY /
VOCATIONAL STA CRUZ ACADEMY HIGH SCHOOL 6/3/1996 3/31/2000 N/A 2000 N/A

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

TRADE
BACHELOR OF ELEMENTARY EDUCATION SPECIALIZATION IN
COURSE
COLLEGE TOMAS DEL ROSARIO COLLEGE ENGLISH 6/5/2000 3/27/2004 N/A 2004 N/A
 MASTER OF ARTS IN EDUCATION MAJOR IN
GRADUATE STUDIES BATAAN PENINSULA STATE UNIVERSITY
EDUCATIONAL MANAGEMENT
6/9/2012 5/20/2016 N/A 2016 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

LICENSURE EXAMINATION FOR TEACHERS 78.6 8/29/2004 HOLY ANGEL UNIVERSITY, ANGELES CITY 0861575 10/2/2019

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
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)
DEPARTMENT OF EDUCATION, LUBAO
6/1/2016 PRESENT TEACHER I 19853.00 11-2 PERMANENT YES
WEST
DEPARTMENT OF EDUCATION, LUBAO
6/1/2015 5/31/2016 TEACHER I 19286.00 11-2 PERMANENT YES
WEST
DEPARTMENT OF EDUCATION, LUBAO
6/1/2014 5/31/2015 TEACHER I 18549.00 11-1 PERMANENT YES
WEST
DEPARTMENT OF EDUCATION, LUBAO
6/1/2013 5/31/2014 TEACHER I 18549.00 11-1 PERMANENT YES
WEST
DEPARTMENT OF EDUCATION, LUBAO
6/1/2012 5/31/2013 TEACHER I 18549.00 11-1 PERMANENT YES
WEST
DEPARTMENT OF EDUCATION, LUBAO
8/23/2011 5/31/2012 TEACHER I 17099.00 11-1 PERMANENT YES
WEST
6/1/2010 4/15/2011 TEACHER MACCIM ROYAL ACADEMY INC. 12000.00 N/A PERMANENT NO

5/15/2009 4/15/2010 TEACHER MACCIM ROYAL ACADEMY INC. 11000.00 N/A CONTRACTUAL NO

5/15/2008 4/15/2009 TEACHER MACCIM ROYAL ACADEMY INC. 10000.00 N/A CONTRACTUAL NO

5/15/2007 4/15/2008 TEACHER MACCIM ROYAL ACADEMY INC. 9000.00 N/A CONTRACTUAL NO

5/15/2006 4/15/2007 TEACHER MACCIM ROYAL ACADEMY INC. 8000.00 N/A CONTRACTUAL NO

5/15/2005 4/15/2006 TEACHER MACCIM ROYAL ACADEMY INC. 4500.00 N/A CONTRACTUAL NO

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

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

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)

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

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)
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
DEPARTMENT OF EDUCATION DIVISION OF
DIVISION ACCREDITATION COURSE FOR DEPED PAMPANGA SCHOOL SPORTS COACHES 4/17/2017 4/19/2017 24.0
PAMPANGA
DEPARTMENT OF EDUCATION DIVISION OF
DIVISION SEMINAR WORKSHOP IN JOURNALISM FOR SCHOOL PAPER ADVISERS 9/2/2016 9/9/2016 32.0
PAMPANGA
DISTRICT SEMINAR ON JOURNALISM OFSCHOOL PAPER ADVISERS AND TEACHER DEPARTMENT OF EDUCATION LUBAO WEST
7/2/2016 7/16/2016 24.0
COACHES(ENGLISH AND FILIPINO) DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
PANDISTRITONG SEMINAR-WORKSYAP SA FILIPINO TUNGO SA GAWAING PANANALIKSIK 6/7/2016 6/9/2016 24.0
DISTRICT
DISTRICT SEMINAR WORKSHOP ON BEGINNING READING AND WRITING WITH THE THEME "HONING TEACHERS' SKILLS IN DEPARTMENT OF EDUCATION LUBAO WEST
TEACHING BEGINNING READING AND WRITING IN THE MOTHER TONGUE" FILIPINO AND ENGLISH 10/28/2015 10/30/2015 24.0
DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
DISTRICT ROLL OUT CONTINUOUS IMPROVEMENT "CI" TRAINING 6/18/2015 6/20/2015 24.0
DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
KINDERGARTEN CATCH-UP EDUCATION PROGRAM TRAINING WORKSHOP 4/15/2015 4/17/2015 24.0
DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
DISTRICT MUSIC TRAINING FOR GRADES 1,2,AND 3 TEACHERS 4/23/2014 4/25/2014 24.0
DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
DISTRICT SEMINAR IN CAMPUS JOURNALISM AND RADIO BROADCASTING 4/21/2014 4/23/2014 24.0
DISTRICT
DISTRICT SEMINAR ON DIFFERENT STRATEGIES IN TEACHING ELEMENTARY MATHEMATICS FOR DEPARTMENT OF EDUCATION LUBAO WEST
4/9/2014 4/11/2014 24.0
UNTRAINED TEACHERS DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
DISTRICT TRAINING ON TEACHER INDUCTION PROGRAM 5/28/2013 5/30/2013 24.0
DISTRICT
DEPARTMENT OF EDUCATION LUBAO WEST
DISTRICT TRAINING WORKSHOP ON CAMPUS JOURNALISM AND RADIO BROADCASTING 4/17/2013 4/19/2013 24.0
DISTRICT
DISTRICT TRAINING OF GRADE 1 TEACHERS ON SCIENTIFIC SKILLS AND BASIC DEPARTMENT OF EDUCATION LUBAO WEST
4/10/2013 4/12/2013 24.0
CONCEPTS IN SCIENCE DISTRICT

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)

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 LITERATE N/A LUBAO WEST TEACHERS ASSOCIATION

LUBAO PUBLIC SCHOOL TEACHERS
COOKING N/A
ASSOCIATION
ASSOCIATION OF PAMPANGA SCHOOL SPORTS ACCREDITED
DANCING N/A COACHES

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)

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:
________________________________
N/A
________________________________
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? ________________________________
N/A
________________________________
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: N/A
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
MARLI H. CURZ SAN ROQUE ARBOL LUBAO PAMAPNGA 9293751410 3.5 cm. X 4.5 cm
(passport size)

MARIA LEILANI T. TRINIDAD STO. TOMAS LUBAO PAMPANGA 9997401513 With full and handwritten
name tag and signature over
printed name
JOVIAN G. GANTANG STA TEREZA 2ND LUBAO PAMPANGA N/A
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: PROFESSIONAL REGULATION COMMISSION

ID/License/Passport No.: 0861575

Signature (Sign inside the box)
04/24/2017
Date/Place of Issuance: 6/15/2016 / MANILA PHILIPPINES
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

YVETTE C. GALVE
ESHT-I
Person Administering Oath

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