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 LOMIBAO

FIRST NAME CRUZALDO NAME EXTENSION (JR., SR)

MIDDLE NAME ZACARIAS

3. DATE OF BIRTH 6/22/1966 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship by naturalization
4. PLACE OF BIRTH Lingayen, Pangasinan If holder of dual citizenship, by Pls. indicate country:
birth
5. SEX please indicate the details.
✘ Male Female
6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESCLUSTER 5 BLOCK 5 , 3 FVR HOUSING ALVEAR II
Widowed House/Block/Lot No. Street
Separated
Other/s: N/A POBLACION
Subdivision/Village Barangay
7. HEIGHT (m) 1.60 LINGAYEN PANGASINAN

8. WEIGHT (kg) 67 ZIP CODE 2401

18. PERMANENT ADDRESS CLUSTER 5 BLOCK 5 , 3 FVR HOUSING ALVEAR II
9. BLOOD TYPE A
House/Block/Lot No. Street
N/A POBLACION
10. GSIS ID NO. B66MNCZL104
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1280-0114-2736 LINGAYEN PANGASINAN

City/Municipality Province
12. PHILHEALTH NO. 19-000825152-9 ZIP CODE 2401

13. SSS NO. 03-9710641-3 19. TELEPHONE NO. 615 4812

14. TIN NO. 121-260-370 20. MOBILE NO. 0930 076 8467

15. AGENCY EMPLOYEE NO. 1998-4307 21. E-MAIL ADDRESS (if an cruzaclom_8873@yahoo.com / cruzaldolomibao@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)

FIRST NAME GEMMA NAME EXTENSION (JR., John Macrul A. Lomibao 06/03/1995
SR)
MIDDLE NAME ULANDAY Macrin Mae A. Lomibao 02/21/1997

OCCUPATION CLERK / AGENT Mac Dazyl A. Lomibao 11/20/1998

EMPLOYER/BUSINESS NAMStronghold Insurance Company, Inc. Mac Iris Gem A. Lomibao 06/07/2002

BUSINESS ADDRESS Mac Arthur Highway, Calasiao, Pangasinan Macril Cyrine A. Lomibao 03/10/2006

TELEPHONE NO. (075) 522-8358

24.FATHER'S SURNAME LOMIBAO (Deceased) 9/9/1937

FIRST NAME AMADO NAME EXTENSION (JR.,
SR)
MIDDLE NAME CRUZ

25. MOTHER'S MAIDEN NAME

SURNAME ZACARIAS (Deceased) 6/29/1934

FIRST NAME VIRGINIA

MIDDLE NAME SANTOS

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

ELEMENTARY Lingayen I Central School PRIMARY EDUCATION 1974 1979 N/A 1979 N/A
VOCATIONAL /
SECONDARY Pangasinan National High School HIGH SCHOOL 1979 1983 N/A 1983 N/A

Bachelor of Science in Industrial

Pangasinan School of Arts and Trades 1983 1985 100 Units 1985 N/A
Education (Drafting)
Pangsinan State University College of Arts and
COLLEGE Bachelor of Science (Mathematics) 1985 1988 GRADUATE 1988 N/A
TRADE COURSE Sciences & Technology

GRADUATE STUDIES Colegio de Daguapn MED-Educational Leadership 2018 2019 45 2019 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE January 5, 2023 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

Professional Board Examination for Teachers 71.85% 12/30/1989 Luzon Colleges Dagupan City 0010322 11/19/1996
07/23/2013 to
Trainors Methodology Certificate I Complied TESDA-PSAT TMC 14010401000005
07/23/18
Housekeeping NC II (Renewal) Passed Oct. 8, 2021 Urdaneta, Pangasinan 21015502067738 Oct. 8, 2026

Housekeeping NC II Passed Jan. 5, 2022 TESDA-P.O. 211801551200718 Oct. 7, 2026

Organic Agriculture Production NC II Passed Nov. 4, 2020 TESDA - PSAT 20015502011592 Nov. 3, 2025

Organic Agriculture Production NC II Passed Dec. 16, 2021 TESDA - P.O. 211801551200706 Nov. 3, 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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
(mm/dd/yyyy)
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP STATUS OF APPOINTMENT
(Format "00-0")/ (Y/
abbreviate) full/Do not abbreviate) INCREMENT
From To N)

11/4/2022 PRESENT Assistant Professor II Pangasinan School of Arts and Trades 38,566.00 16-2 Permanent Yes
01/01/2022 11/3/2022 Assistant Professor II Pangasinan School of Arts and Trades 38,150.00 16-2 Permanent Yes
01/01/2021 12/31/2021 Assistant Professor II Pangasinan School of Arts and Trades 36,628.00 16-1 Permanent Yes
01/01/2020 12/31/2020 Assistant Professor II Pangasinan School of Arts and Trades 35,106.00 16-1 Permanent Yes
11/04/2019 12/31/2019 Assistant Professor II Pangasinan School of Arts and Trades 33,584.00 16-1 Permanent Yes
01/01/2019 11/03/2019 Instructor III Pangasinan School of Arts and Trades 27,755.00 14-1 Permanent Yes

01/01/2018 12/31/2018 Instructor III Pangasinan School of Arts and Trades 26,494.00 14-1 Permanent Yes

07/03/2017 12/31/2017 Instructor III Pangasinan School of Arts and Trades 25,290.00 14-1 Permanent Yes

01/01/2017 07/02/2017 Instructor II Pangasinan School of Arts and Trades 23,517.00 13-2 Permanent Yes

01/01/2016 12/31/2016 Instructor II Pangasinan School of Arts and Trades 22,564.00 13-2 Permanent Yes

09/16/2015 12/31/2015 Instructor II Pangasinan School of Arts and Trades 21,650.00 13-2 Permanent Yes

09/16/2012 09/15/15 Instructor II Pangasinan School of Arts and Trades 21,436.00 13-1 Permanent Yes

06/01/2012 09/15/2012 Instructor I Pangasinan School of Arts and Trades 20,545.00 12-4 Permanent Yes

12/16/2011 05/31/2012 Instructor I Pangasinan School of Arts and Trades 19,047.00 12-4 Permanent Yes

06/01/2011 12/15/2011 Instructor I Pangasinan School of Arts and Trades 18,805.00 12-3 Permanent Yes

06/24/2010 05/31/11 Instructor I Pangasinan School of Arts and Trades 17,269.00 12-3 Permanent Yes

07/01/2009 6/232010 Instructor I Pangasinan School of Arts and Trades 15,733.00 12-3 Permanent Yes

12/16/2008 06/30/2009 Instructor I Pangasinan School of Arts and Trades 14,197.00 12-3 Permanent Yes

07/01/2008 12/15/2008 Instructor I Pangasinan School of Arts and Trades 13,850.00 12-2 Permanent Yes

07/01/2007 06/30/2008 Instructor I Pangasinan School of Arts and Trades 12,591.00 12-2 Permanent Yes

12/16/2005 06/30/2007 Instructor I Pangasinan School of Arts and Trades 11,446.00 12-2 Permanent Yes

12/16/2002 12/15/2005 Teacher I Pangasinan School of Arts and Trades 11,167.00 12-1 Permanent Yes

07/01/2001 12/15/2002 Teacher I Pangasinan School of Arts and Trades 10,442.00 10-3 Permanent Yes

01/01/2000 06/30/2001 Teacher I Pangasinan School of Arts and Trades 9,703.00 10-2 Permanent Yes

11/23/1999 12/31/1999 Teacher I Pangasinan School of Arts and Trades 9,041.00 10-2 Permanent Yes

11/01/1999 11/22/1999 Teacher I Pangasinan School of Arts and Trades 8,821.00 10-2 Permanent Yes

11/01/1997 10/31/1999 Teacher I Pangasinan School of Arts and Trades 8,605.00 10-1 Permanent Yes

01/01/1997 10/31/1997 Teacher I Pangasinan School of Arts and Trades 7,309.00 10-1 Permanent Yes

08/16/1996 12/31/1996 Teacher I Pangasinan School of Arts and Trades 6,013.00 10-1 Permanent Yes

01/01/1996 08/15/1996 Teacher I Sual High School, Sual Pangasinan 6,013.00 10-1 Permanent Yes

08/16/1995 12/31/1995 Teacher I Sual High School, Sual Pangasinan 4,902.00 N/A Permanent Yes

01/01/1995 08/15/1995 Teacher I Doyong H.S. San Carlos City 4,902.00 N/A Permanent Yes

01/01/1994 12/31/1994 Teacher I Doyong H.S. San Carlos City 3,902.00 N/A Permanent Yes

11/25/1993 12/31/1993 Teacher I Doyong H.S. San Carlos City 3,102.00 N/A Permanent Yes

06/14/1989 03/27/1991 Secondary School Teacher Grinhar (College) Academy Biñan, Laguna 1,600.00 N/A Permanent Yes

(Continue on separate sheet if necessary)

SIGNATURE DATE January 5, 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 Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY (Write
(Write in full) (mm/dd/yyyy)
HOURS Supervisory/ in full)
Technical/etc)
From To
In-Company Trainers' Methodology Level I Multiplier Training 10/03/2022 10/21/2022 120 TECHNICAL TESDA - PSAT, Lingayen, Pang.
RCEF-RESP Training of Trainers (ToT) on Pest and Nutrients Management 07/25/2022 07/29/2022 40 TECHNICAL NTA-PhilRice, City of Batac, 2906 Ilocos Norte
Orientation on Biometrics-Enabled Scholarship Registration System (BSRS) 03/16/2022 03/16/2022 8 TECHNICAL TESDA - PSAT, Lingayen, Pang.
Skills Upgrading (Crash Course) in Masonry NC II 11/25/2021 11/28/2021 32 TECHNICAL TESDA - PSAT, Lingayen, Pang.
1st Joint TTI Pangasinan Staff development Program 11/16/2021 11/16/2021 8 TECHNICAL TESDA - PSAT, Lingayen, Pang.

Training of Trainers on Entrepreneurship Development 10/9/2021 10/13/2021 40 TECHNICAL TESDA - PSAT, Lingayen, Pang.

Training on Housekeeping NC II 9/6/2021 9/10/2021 40 TECHNICAL TESDA - PSAT, Lingayen, Pang.

Capacity Building program for Enterprise-Based Training (EBT) Industry
02/23/2021 02/24/2021 16 TECHNICAL TESDA Region 1 LA UNION
Coordinators and TTI Administrators (Part 1)
Preparation for the Registration of Flexible Learning Delivery 06/22/2020 06/26/2020 40 TECHNICAL TESDA - PSAT, Lingayen, Pang.
Orientation Program on Flexible Learning Training Modality 06/07/2020 06/08/2020 16 TECHNICAL TESDA - PSAT, Lingayen, Pang.

Practicing COVID-19 Preventive Measures in the Workplace 06/01/2020 06/01/2020 8 TECHNICAL TESDA - PSAT, Lingayen, Pang.

Learning Session on TVET Governance 12/12/2019 12/12/2019 8 TECHNICAL 567 Event Place, Baybay Lopez, Binmaley, Pang.

Dual Training System (DTS) Orientation 10/29/2019 10/29/2019 8 TECHNICAL TESDA at Hotel Ariana, Paringao, Bauang, La Union

Orientation on Enterprise-Based Training (EBT) Programs and Dual Training System 09/17/2019 09/17/2019 8 TECHNICAL TESDA at Dagupan City Museum, Dagupan City

Trainers Skills Upgrading Program (Industry 4.0 Immersion) 06/03/2019 06/07/2019 40 TECHNICAL TESDA-NTTA with Hytec Power Inc. Novaliches, Quezon City
Strategic Planning and Implementation 03/21/2019 03/22/2019 16 TECHNICAL TESDA-PSAT, Lingayen, Pang.

DTS Capability Build-Up Program on the Development of Training Plan 07/25/2018 07/26/2018 16 TECHNICAL TESDA at Hotel Ariana, Paringao, Bauang, La Union

TVET National Assessment Standardization of Procedures 03/09/2018 03/09/2018 8 TECHNICAL President's Hotel Lingayen Pangasinan
Housekeeping NC III Trainers Skills Upgrading Program 10/15/2017 10/27/2017 80 TECHNICAL TESDA - CENTRAL OFFICE Taguig City

One TESD Summit Cycle 2 09/14/2016 09/14/2016 8 TECHNICAL Sison Auditorium Lingayen Pangasinan
Writeshop on Curriculum Development for Higher TESD 11/26/2013 11/28/2013 24 TECHNICAL TESDA XI RTC

Basic Course on Dual Training Industrial Coordination 09/16/2013 11/28/2013 32 TECHNICAL TESDA CENTRAL OFFICE TAGUIG CITY

ASSESSMENT MODERATION 09/27/2012 09/27/2012 8 TECHNICAL TESDA Region 1 LA UNION

Computer Literacy Training 01/11/2010 01/15/2010 40 TECHNICAL TESDA - PSAT Lingayen Pangasinan
VALUES
VALUE AWARENESS, Proper Conduct of an Assessor 06/02/2011 06/02/2011 8 TESDA Provincial Office, Pangasinan
DEVELOPMENT
Orientation-Workshop on Administrative Procedure 06/24/2009 06/26/2009 24 ADMINISTRATIVE TESDA Region 1 LA UNION

Orientation on RA 9485(Anti-Red Tape Act of 2007) 12/11/2008 12/12/2008 16 TECHNICAL Civil Service Commision

Basic Reflexology Seminar-Workshop 02/27/2008 02/29/2008 24 TECHNICAL TESDA - PSAT

Competency Assessment Methodology Course 11/03/2008 11/07/2008 40 TECHNICAL TESDA - PSAT

Trainers Methodology Training Program 04/16/2007 04/18/2007 24 TECHNICAL TESDA - PSAT

10 MONTH Personal and Professional Enhancement Program 03/25/2004 03/25/2004 8 TECHNICAL TESDA - PSAT

Seminar-Workshop On Teambuilding 06/11/2002 06/12/2002 20 TECHNICAL TESDA - PSAT

Mathematics for Construction Technology Trainors Course 05/13/2002 05/17/2002 40 TECHNICAL TESDA-NITVET

Revised TESDA Performance Evaluation System Seminar-Workshop 05/24/2001 05/25/2001 16 TECHNICAL TESDA - PSAT

Mathematics for Technology Education Course 08/28/2000 09/01/2000 40 TECHNICAL TESDA-NITVET

Mathematics for Technology 04/05/1999 04/07/1999 24 TECHNICAL Division of Natural Sci. and Math at UP College Baguio, City
VALUES
Moral and Spiritual Recovery Program 02/20/1995 02/20/1995 8 DEVELOPMENT
PNP Values Formation Council, Inc. Sual HS

Pangasinan Fitness and Sports Clinic 10/02/1994 10/06/1994 40 TECHNICAL Phil. Sports Commission at PNHS Lingayen, Pangasinan

Regional Accreditation Seminar on SIPA/SEPAK TAKRAW 08/10/1994 08/12/1994 24 TECHNICAL DECS Region I

Two-Day Division SEDP Training for Untrained Teachers (Math) 05/08/1994 05/09/1994 16 TECHNICAL DECS Div. of City Schools San Carlos City
Innovative Teaching Strategies for Todays Teachers 12/01/1990 12/01/1990 8 TECHNICAL Rex Book Store at 7 Michael Institute

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION

31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

Drafting

Sepak Takraw

Housekeeping / Farmers Field School

LINGAYEN African Lovebirds
LOVEBIRDS BREEDER
(ALBS 1 & 2 ) Owners and Breeders

(Continue on separate sheet if necessary)

SIGNATURE DATE January 5, 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,
YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO NTT
C
1414
0P10
35. a. Have you ever been found guilty of any administrative offense? 4123
YES ✘ NO 9865
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:
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
VERNA NAVA PEREZ 55 Castillo St. Lingayen, Pangasinan N/A 3.5 cm. X 4.5 cm
(passport size)

PEEJAY S. BENAVIDES DAGUPAN CITY PANGASINAN 9222887764 With full and handwritten
name tag and signature over
printed name
GERARDO E. AMANSEC LINGAYEN PANAGASINAN 9338241131
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete is not acceptable
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 administrative/criminal case/s PHOTO
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: UMID I.D. CRUZALDO Z. LOMIBAO

ID/License/Passport No.: CRN-006-0100-8624-1 Signature (Sign inside the box)

January 5, 2023
Date/Place of Issuance: Valid Until: August, 2027
Date Accomplished Right Thumbmark

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

LIZA M. VICTORIO
Administrative Officer IV
Person Administering Oath

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