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 MEGALLOS
NAME EXTENSION (JR., SR)
FIRST NAME MARVIN

MIDDLE NAME PAMPLONA

3. DATE OF BIRTH
3/12/1992 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship by
by
naturalizatio
birth
4. PLACE OF BIRTH TIBAL-OG, STO.TOMAS DAVAO DEL NORTE If holder of dual citizenship, n
Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

House/Block/Lot No. Street
Widowed Separat
CAPITOL HOMES MANKILAM
Other/s: ed Subdivision/Village Barangay
TAGUM CITY DAVAO DEL NORTE
7. HEIGHT (m) 1.68m
City/Municipality Province
8. WEIGHT (kg) 70KG ZIP CODE 8100
18. PERMANENT ADDRESS
9. BLOOD TYPE O
House/Block/Lot No. Street
CAPITOL HOMES MANKILAM
10. GSIS ID NO. N/A
Subdivision/Village Barangay
TAGUM CITY DAVAO DEL NORTE
11. PAG-IBIG ID NO. 1211-6837-2156
City/Municipality Province
12. PHILHEALTH NO. 16-201134153-5 ZIP CODE 8100

13. SSS NO. 09-4066648-1 19. TELEPHONE NO. N/A

14. TIN NO. 485-430-478 20. MOBILE NO. 0956-755-9052 / 0907-420-2144

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

MIDDLE NAME GLUDO

OCCUPATION PUBLIC TEACHER

EMPLOYER/BUSINESS NAME DEPARTMENT OF EDUCATION- DIVISION OF TAGUM

BUSINESS ADDRESS PAGSABANGAN ELEMENTARY SCHOOL

TELEPHONE NO. N/A

24. FATHER'S SURNAME MEGALLOS

NAME EXTENSION (JR., SR)
FIRST NAME ANSELMO

MIDDLE NAME SUMATRA

25. MOTHER'S MAIDEN NAME

SURNAME PAMPLONA

FIRST NAME GLORIA

MIDDLE NAME REYES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY STO.TOMAS CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1999 2005 GRADUATED 2005 WITH HONORS

SECONDARY STO. TOMAS NATION HIGH SCHOOL HIGH SCHOOL 2005 2009 GRADUATED 2009 WITH HONORS
VOCATIONAL /
N.A N.A N.A N.A N.A N.A N.A

TRADE COURSE N.A N.A N.A N.A N.A N.A N.A

QUEEN OF APOSTLES COLLEGE SEMINARY AB CLASSICAL MAJOR IN PHILOSOPHY 2010 2014 GRADUATED 2014 DIPLOMA
COLLEGE
NORTH DAVAO COLLEGE FOUNDATION, INC.-
TAGUM
BSED MAJOR IN VALUES EDUCATION 2017 2018 18 2018 EARNERS

GRADUATE STUDIES ST. MARY'S COLLEGE OF TAGUM, INC. MAED- GUIDANCE AND COUNSELLING 2019 2022 36 N.A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 05,2023

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

LICENSURE EXAMINATION FOR TEACHERS 83.00 SEPTEMBER 29, 2019 DAVAO CITY 1872646 3/12/2026

(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
(mm/dd/yyyy) MONTHLY PAY GRADE (if 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)
8/1/2022 Present COLLEGE INSTRUCTOR ASSUMPTION COLLEGE OF NABUNTURAN P4,200 N/A PART-TIME NO

6/1/2022 5/31/2023 JUNIOR HIGH TEACHER/CSA/SSC MODERATOR ASSUMPTA SCHOOL OF TAGUM P12,100 N/A REGULAR NO

8/1/2021 6/15/2022 COLLEGE INSTRUCTOR ASSUMPTION COLLEGE OF NABUNTURAN P8,400 N/A PART-TIME NO

6/1/2021 5/31/2022 JUNIOR HIGH TEACHER/CSA/SSC MODERATOR ASSUMPTA SCHOOL OF TAGUM P12,100 N/A REGULAR NO

8/1/2020 6/15/2021 COLLEGE INSTRUCTOR ASSUMPTION COLLEGE OF NABUNTURAN P2,100 N/A PART-TIME NO

6/1/2020 4/30/2021 JUNIOR HIGH TEACHER/CSA/SSC MODERATOR ASSUMPTA SCHOOL OF TAGUM P11,800 N/A CONTRACTUAL NO

6/1/2019 4/30/2020 JUNIOR HIGH TEACHER/CSA/SSC MODERATOR ASSUMPTA SCHOOL OF TAGUM P11,800 N/A CONTRACTUAL NO

6/1/2018 4/30/2019 JUNIOR HIGH TEACHER/CSA/SSC MODERATOR ASSUMPTA SCHOOL OF TAGUM P10,000 N/A CONTRACTUAL NO

6/1/2017 4/30/2018 JUNIOR HIGH TEACHER ASSUMPTA SCHOOL OF TAGUM P10,000 N/A CONTRACTUAL NO

6/1/2016 4/30/2017 JUNIOR HIGH TEACHER ASSUMPTA SCHOOL OF TAGUM P8,000 N/A CONTRACTUAL NO
 (Continue on separate sheet if necessary)
SIGNATURE DATE June 05, 2023
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 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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)

TECHNICAL EDUCATION AND SKILLS

NC II- COMPUTER SYSTEM SERVICING 9/1/2022 12/5/2022 120 hrs Technical
DEVELOPMENT

FACULTY DEVELOPMENT SESSION AND WORKSHOP ON

CURRICULUM DEVELOPMENT
7/4/2022 7/7/2022 32 hrs Technical ASSUMPTA SCHOOL OF TAGUM,INC.

CATHOLIC SCHOOLS AND THE EVANGELIZING

MISSION IN MINDANAO:A SHARED JOURNEY
2/23/2022 2/23/2022 8 hrs Technical DAVAO ASSOCIATION OF CATHOLIC SCHOOL,INC.
TOWARDS PEACE,TRANSFORMATION AND
SOLIDARITY

INTEGRATING STUDENT ACTIVITY PROGRAMS IN

DISTANCE LEARNING CURRICULUM
1/15/2022 1/15/2022 8 hrs Technical PHOENIX PUBLISHING HOUSE

THE FUTURE OF CATHOLIC EDUCATION IN THE

PHILIPPINES: CHANGES, CHALLENGES. CHANCES
11/25/2021 11/25/2021 8 hrs Technical DON BOSCO PRESS INC.

TEACHING AND ASSESSING THE K-12 STANDARDS PRIVATE EDUCATION ASSISTANCE COMMITTEE
7/12/2021 7/14/2021 24 hrs Technical
ACROSS THE DIFFERENT LEARNING MODALITIES (PEAC)

SCHOOLOGY:EMPOWERING 21ST CENTURY

7/8/2021 7/9/2021 12 hrs Technical REXSCHOOLOGY
LEARNING

THE NEW NOW: HYBRID LEARNING 4/30/2020 4/30/2020 8 hrs Technical VIBAL

THE USE OF VARIED ASSESTMENT TOOLS AND IN-

1/31/2020 1/31/2020 8 hrs Technical ASSUMPTA SCHOOL OF TAGUM,INC.
DEPTH TREATMENT OF CONTENT

YOUTH LEADER: BELOVED, GIFTED AND

7/12/2019 7/13/2019 16 hrs Technical DACET
EMPOWERED

THE ART OF QUESTIONING,VALUES

INTEGRATION AND CLASSROOM 6/24/2018 6/25/2018 12 hrs Technical ASSUMPTA SCHOOL OF TAGUM,INC.
MANAGEMENT
TRANSFORMATIONAL TEACHING FOR THE 21ST
1/20/2018 1/20/2018 6 hrs Technical PHOENIX PUBLISHING HOUSE
CENTURY LEARNERS

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 33. (Write in
(Write in full)
full)
Organization and Time Management SERVICE AWARD LECTORS MINISTRY-REMASE
Competence with Education Technology KNIGHTS OF COLUMBUS-SMP
Encoding YOUTH FORMATORS-SMP
Leadership Skills BUKAS LOOB SA DYOS-QACS
Logical Mathematical Skill

(Continue on separate sheet if necessary)

SIGNATURE DATE June 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,
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
a.
items:
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
FMA Convent, Purok Cabanisas , the last 6 months
SR. JULIE P. ROMA, fma Mankilam, Tagum City
919 7963 465 3.5 cm. X 4.5 cm
(passport size)

MRS. RUTH JATIVA Lorenzo Village, Tipaz, Tagum City 9173053033 With full and handwritten
name tag and signature over
Villa Cacacho, Mankilam, Tagum printed name
MRS. LUZ B. ROMUALDO City
9975725708
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

ID/License/Passport No.: 1872646

 ID/License/Passport No.: 1872646
Signature (Sign inside the box)
06/05/2023
Date/Place of Issuance: 02/12/2020 DAVAO CITY
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