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

MIDDLE NAME ESCANILLA

3. DATE OF BIRTH
(mm/dd/yyyy) OCTOBER 15,1993 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH LA CARLOTA CITY 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 N/A
Widowed Separated House/Block/Lot No. Street
SITIO CAROLINA BARANGAY 2
Other/s:
Subdivision/Village Barangay
LA CARLOTA CITY NEGROS OCCIDENTAL
7. HEIGHT (m) 1.524
City/Municipality Province
8. WEIGHT (kg) 49 ZIP CODE 6130

18. PERMANENT ADDRESS

9. BLOOD TYPE AB-
House/Block/Lot No. Street
SITIO CAROLINA BARANGAY 2
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LA CARLOTA CITY NEGROS OCCIDENTAL
11. PAG-IBIG ID NO. 121172868730
City/Municipality Province

12. PHILHEALTH NO. 112521988390 ZIP CODE 6130

13. SSS NO. 07329 65167 19. TELEPHONE NO. N/A

14. TIN NO. 330290980 20. MOBILE NO. 09665434095

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) oticochristine@yahoo.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 N/A
MIDDLE NAME N/A
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME OTICO
FIRST NAME DIONISIO
MIDDLE NAME DUCLAYNA
25. MOTHER'S MAIDEN NAME

SURNAME ESCANILLA
FIRST NAME LOLITA
MIDDLE NAME FRANCISCO (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
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ARTIST OF
ELEMENTARY LA CARLOTA SOUTH ELEMENTARY SCHOOL II PRIMARY EDUCATION 2001 2007 N/A 2007
THE YEAR
DONA HORTENCIA SALAS BENEDICTO NATIONAL
VOCATIONAL
SECONDARY /
HIGH SCHOOL HIGH SCHOOL 2007 2011 N/A 2011 N/A

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

TRADE BACHELOR IN SECONDARY EDUCATION MAJOR
COLLEGE
COURSE LA CARLOTA CITY COLLEGE
IN ENGLISH
2011 2015 N/A 2015 N/A

MASTER OF ARTS IN EDUCATION MAJOR IN

GRADUATE STUDIES LA ACRLOTA CITY COLLEGE
ENGLISH
2017 2019 27 N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE January 13, 2023

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) CONFERMENT NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE Date of
Validity
SEPTEMBER 27,
LET LICESSURE EXAMINATION FOR TEACHERS 78.4 2015
BACOLOD CITY 1434419 10/15/2025

(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.

28. INCLUSIVE DATES SALARY/ JOB/ GOV'T SERVICE

(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
MONTHLY applicable)& STATUS OF
SALARY STEP (Format APPOINTMENT
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) "00-0")/ (Y/
INCREMENT
N)
From To

DONA HORTENCIA SALAS BENIDICTO

OCTOBER 5,2020 PRESENT SEF TEACHER NATIONAL HIGH SCHOOL - AYUNGON 8,000 N/A CONTRACTUAL Y
EXTENSION

VMA GLOBAL COLLEGE AND

JUNE 1, 2018 APRIL 15,2019 SHS TEACHER 11, 990 N/A CONTRACTUAL N
TRAINING CENTERS INC.

FEBRUARY STI WEST NEGROS INSTITUTE OF

JANUARY 4, 2018 ESL TEACHER 8, 000 N/A CONTRACTUAL N
23, 2018 LANGUAGE

NOVEMBER
JUNE 9, 2016 ESL TEACHER MY PICTEACH COMPANY INC. 13,500 N/A CONTRACTUAL N
15, 2017

(Continue on separate sheet if necessary)

SIGNATURE DATE January 13, 2023

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 NUMBER OF
(Write in full) (mm/dd/yyyy) 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 ATTENDANCE

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

From To

DONA HORTENCIA SALAS BENEDICTO

GENDER AND EQUALITY DEVELOPMENT 12/19/2022 12/19/2022 8 MANAGERIAL NATIONAL HIGH SCHOOL, DIVISION OF LA
CARLOTA CITY

RE-ORIENTATION OF RESULTS-BASED PERFROMANCE DONA HORTENCIA SALAS BENEDICTO

MANAGEMENT-PHILIPPINE PROFESSIONAL STANDARDS FOR 12/4/2022 12/4/2022 8 MANAGERIAL NATIONAL HIGH SCHOOL, DIVISION OF LA
TEACHERS FOR S.Y. 2021-2022 CARLOTA CITY

MID-YEAR BREAK INSET 2022: SCHOOL MENTAL HEALTH, DONA HORTENCIA SALAS BENEDICTO
EDUCATIONAL PPAs, TEACHERS AND SCHOOL STAFFS' 3/2/2022 5/2/2022 24 MANAGERIAL NATIONAL HIGH SCHOOL, DIVISION OF LA
PERFORMANCE, SAT & DIVERS LEARNERS' NEEDS CARLOTA CITY

DONA HORTENCIA SALAS BENEDICTO

INTEGRATION OF BROADCAST SCRIPT TO VIDEO-BASED
6/9/2021 7/9/2021 16 TECHNICAL NATIONAL HIGH SCHOOL, DIVISION OF LA
INSTRUCTION
CARLOTA CITY

OFFICE OF THE UNDERSECRETARY FOR

VIRTUAL IN- SERVICE TRAINING FOR TEACHERS 08/30/2021 3/9/2021 40 MANAGERIAL
ADMINISTRATION (OUA)
WRITER AND VOCIE TALENT OF ENGLISH GRADE 8 QUARTER 4,
06/25/2021 06/25/2021 8 TECHNICAL SDO-LA CARLOTA CITY, PHILIPPINES
LAS 5 RBI

VOICE TALENT OF ENGLISH GRADE 8 QAURTER 4 LAS 1 RBI 06/18/2021 06/18/2021 8 TECHNICAL SDO-LA CARLOTA CITY, PHILIPPINES

WRITER OF ENGLISH 8 QAURTER 4 MELC 1 RBI 1 11/6/2022 11/6/2022 8 TECHNICAL SDO-LA CARLOTA CITY, PHILIPPINES

SCHOOL-BASED INSET 2021: STRENGTHENING TEACHER'S DONA HORTENCIA SALAS BENEDICTO

DIMENSION, ADAPTATION AND ACCOMMODATION DURING THE 03/15/2021 03/19/2021 40 MANAGERIAL NATIONAL HIGH SCHOOL, DIVISION OF LA
PANDEMIC CARLOTA CITY

VIRTUAL SCHOOL-LED INSET 2021: ISSUES, CONCERNS, AND DONA HORTENCIA SALAS BENEDICTO
CHALLENGES OF LDM, ASSESSMENT AND GRADING, AND 8/2/2021 02/13/2021 40 MANAGERIAL NATIONAL HIGH SCHOOL, DIVISION OF LA
UPDATES ON THE UTILIZATION OF LAS CARLOTA CITY

DHSBNHS VIRTUAL INSET 2020: GENDER EQUALITY, MENTAL DONA HORTENCIA SALAS BENEDICTO
AWARENESS, TOS, AND DEVELOPMENT ASSESSMENT WITH 12/14/2020 12/18/2020 40 MANAGERIAL NATIONAL HIGH SCHOOL, DIVISION OF LA
ACADEMIC EASE AMIDST PANDEMIC CARLOTA CITY

TEACHING ENGLISH TO SPEAKERS OF OTHER LANGUAGES AND TEACH INTERNATIONAL ENGLISH LANGUAGE
3/3/2020 04/13/2020 140 MANAGERIAL
TEACHING ENGLISH TO YOUNG LEARNERS SCHOOL

PROCTORSHIP FOR BEAA 02/13/2019 02/14/2019 10 MANAGERIAL BACOLOD CITY NATIONAL HIGH SCHOOL

VMA GLOBAL COLLEGE AND TRAINING

THE ART OF QUESTIONING AND TABLE OF SPECIFICATION 06/16/2018 06/18/2018 8 MANAGERIAL
CENTERS, INC.

GRANDE COMPUTER OUTREACH AND

BASIC COMPUTER COURSE 12/17/2016 12/27/2016 80 TECHNICAL
TRAINING CENTER INC.

(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)

ABLE TO WORK IN TEAMS N/A N/A

ABLE TO DEAL WITH KIDS AND ADULTS

HAS KNOWLEDGE IN MICROSOFST OFFICE

WORD, EXCEL, POWER POINT, AND
PUBLISHER
READING BOOKS
LISTENING TO MUSIC
DO ANYTHING RELATED TO ARTS
PASSIONATE IN TEACHIING
(Continue on separate sheet if necessary)

SIGNATURE DATE January 13, 2023

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
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 the YES ✘ NO
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:
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
MS. DYLENE OMBAN TALISAY CITY 9159094290 3.5 cm. X 4.5 cm
(passport size)

DR. MAYLIN M. TONGCUA LA CARLOTA CITY 9151163728 With full and handwritten
name tag and signature over
printed name
MS. RAY ANN GRACE GENOBIS BACOLOD CITY 9227902112
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

ID/License/Passport No.: 1434419

Signature (Sign inside the box)

Date/Place of Issuance: BACOLOD CITY

Date Accomplished Right Thumbmark

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

Person Administering Oath

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