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 MACALINO
NAME EXTENSION (JR., SR)
FIRST NAME JEFFREY

MIDDLE NAME MANUEL

3. DATE OF BIRTH
01/31/1984 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH LIMAY, BATAAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed House/Block/Lot No. Street

Separate
Other/s: d
Subdivision/Village Barangay
7. HEIGHT (m) 1.75
City/Municipality Province
8. WEIGHT (kg) 118 ZIP CODE

18. PERMANENT ADDRESS

9. BLOOD TYPE A-
House/Block/Lot No. Street

10. GSIS ID NO. 2004144583

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121090227027

City/Municipality Province

12. PHILHEALTH NO. 07-025228472-7 ZIP CODE

13. SSS NO. 33-6228186-5 19. TELEPHONE NO.

14. TIN NO. 263-168-246-0827 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME MACALINO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME GRACE SYRILL A. MACALINO 12/09/2003

MIDDLE NAME ADAME DENICE FIONA A. MACALINO 01/15/2007

OCCUPATION N/A JEAN LORRAINE C. MACALINO 01/14/2011

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME MACALINO

NAME EXTENSION (JR., SR)
FIRST NAME JOSE

MIDDLE NAME CLARIÑO

25. MOTHER'S MAIDEN NAME

SURNAME MANUEL

FIRST NAME SUSAN

MIDDLE NAME HIPOLITO (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

ST. MICHAEL KINDERGARTEN AND ELEMENTARY

ELEMENTARY PRIMARY EDUCATION 1990 1996 N/A 1996 WITH HONORS
SCHOOL

SECONDARY /
VOCATIONAL BATAAN POLYTECHNIC STATE COLLEGE HIGH SCHOOL 1996 2000 N/A 2000 NONE

AMA COMPUTER LEARNING CENTER - BALANGA COMPUTER SYSTEM AND NETWORKING

2001 2003 N/A 2003 WITH HONORS
CITY TECHNOLOGY
TRADE
COURSE
COLLEGE LIMAY POLYTECHNIC COLLEGE B.S. EDUCATION MAJOR IN MATHEMATICS 2004 2008 N/A 2008 BEST S.T.

GRADUATE STUDIES PAMPANGA STATE AGRICULTURAL UNIVERSITY M.A. EDUCATION MAJOR IN MATHEMATICS 2013 2015 33 UNITS 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

LICENSURE EXAMINATION FOR TEACHERS 0.8 9/28/2008 PULUNG BULU ELEMENTARY SCHOOL - ANGELES CITY 0997682 1/31/2024

(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)

01/01/2018 01/31/2019 SST - I MABALACAT COMMUNITY HIGH SCHOOL 20,698.00 11-2 PERMANENT Y

03/21/2017 12/31/2017 SST - I MABALACAT COMMUNITY HIGH SCHOOL 20,088.00 11-2 PERMANENT Y

01/01/2017 03/20/2017 SST - I MABALACAT COMMUNITY HIGH SCHOOL 19,853.00 11-2 PERMANENT Y

01/01/2016 12/31/2016 SST - I MABALACAT COMMUNITY HIGH SCHOOL 19,286.00 11-2 PERMANENT Y

03/21/2014 12/31/2015 SST - I DUQUIT HIGH SCHOOL 18,735.00 11-2 PERMANENT Y

06/01/2012 03/20/2014 SST - I DUQUIT HIGH SCHOOL 18,549.00 11-1 PERMANENT Y

06/01/2011 05/31/2012 SST - I DUQUIT HIGH SCHOOL 17,099.00 11-1 PERMANENT Y

03/21/2011 05/31/2011 SST - I DUQUIT HIGH SCHOOL 15,649.00 11-1 PERMANENT Y

(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

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
UNESCO ASIA PACIFIC NETWORK FOR INTERNATIONAL
SEMINAR-WORKSHOP ON PEACE EDUCATION AND CONFLICT RESOLUTION 05/22/2018 05/24/2018 24.0 MANAGERIAL
ED AND VALUES ED

EHRIS SEMINAR WORKSHOP 02/12/2018 02/13/2018 16.0 MANAGERIAL DEPED MABALACAT CITY

DON HONORIO VENTURA TECHNOLOGICAL STATE

UNDERSTANDING STUDENTS' UNBECOMING BEHAVIOR 05/30/2017 06/01/2017 24.0 MANAGERIAL
UNIVERSITY

MICROSOFT EDUCATION AMBASSADOR PROGRAM 2017 01/25/2017 01/27/2017 24.0 MANAGERIAL MICROSOFT PHILIPPINES

DCP AND ENROLLMENT FOR LIS SEMINAR WORKSHOP 06/09/2016 06/10/2016 16.0 MANAGERIAL DEPED MABALACAT CITY

PAMPANGA FEDERATION OF TECHNICAL INSTITUTIONS

TRAINING METHODOLOGY LEVEL 1 05/04/2015 05/28/2015 160.0 MANAGERIAL
NATIONAL TVET ACADEMY

(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 TECHNICIAN CERTIFICATE OF APPRECIATION - LIS EBEIS ENCODING 2013-2014 DATA N/A

CERTIFICATE OF RECOGNITION - CHARIMAN IN TECH OP COMMITTEE OF THE DIVISION TECH WORKING GROUP
IMAGE EDITING
FOR DIVISION SCHOOLS PRESS CONFERENCE

VIDEO EDITING

MATH PUZZLES

RUBICS CUBE

DRIVING

(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 ✘

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? ________________________________
RESIGNATION
________________________________
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
ROMMEL ARELLANO LIMAY, BATAAN 9499810937 4.5 cm. X 3.5 cm
(passport size)

MAGNO MANUEL JR. LIMAY, BATAAN 9052663023

Computer generated
or photocopied picture
is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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.: 0997682

Signature (Sign inside the box)

Date/Place of Issuance: 12/19/2008 - MANILA

Date Accomplished Right Thumbmark

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

JENNIFER G. SOTTO
Person Administering Oath

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