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 (Do not fill up. For CSC use only)
No.

I. PERSONAL INFORMATION
2. SURNAME MONTEMAYOR
NAME EXTENSION (JR., SR)
FIRST NAME MONESSE ANGELA

MIDDLE NAME ANTIPOLO

3. DATE OF BIRTH
(mm/dd/yyyy) 08/10/1998 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH
VALENZUELA 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 47 A. CHRISTMAS STREET

Widowed Separated House/Block/Lot No. Street
Other/s: STA. LUCIA VILLAGE PHASE 4 PUNTURIN
Subdivision/Village Barangay
7. HEIGHT (m)
1.63 m VALENZUELA CITY METRO MANILA
City/Municipality Province
8. WEIGHT (kg) 101 kg ZIP CODE 1447

9. BLOOD TYPE N/A 18. PERMANENT ADDRESS 47 A. CHRISTMAS STREET

House/Block/Lot No. Street
10. GSIS ID NO. N/A STA. LUCIA VILLAGE PHASE 4 PUNTURIN
Subdivision/Village Barangay
11. PAG-IBIG ID NO. 1212-7359-7902 VALENZUELA CITY METRO MANILA
City/Municipality Province

12. PHILHEALTH NO. 02-251160372-6 ZIP CODE 1447

13. SSS NO. 34-9622276-1 19. TELEPHONE NO. N/A

14. TIN NO. 382-853-823-0000

20. MOBILE NO. 0906-543-4643

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) monesseangela10@gmail.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)
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 MONTEMAYOR
NAME EXTENSION (JR., SR)
FIRST NAME RAMON
MIDDLE NAME FELICIANO
25. MOTHER'S MAIDEN NAME

SURNAME ANTIPOLO
FIRST NAME MARISSA
MIDDLE NAME DIAZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSHIP/
26. PERIOD OF ATTENDANCE HIGHEST LEVEL/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC
LEVEL UNITS EARNED
(Write in full) (Write in full) (if not graduated)
GRADUATED HONORS
RECEIVED
From To
ST. GREGORY SCHOOL OF
ELEMENTARY PRIMARY EDUCATION 2005 2011 2011 N/A
VALENZUELA

SECONDARY ST. JOSEPH SCHOOL OF LAWANG BATO HIGH SCHOOL 2011 2015 2015

VOCATIONAL /
TRADE COURSE
N/A

BACHELOR OF SECONDARY EDUCATION

COLLEGE MEYCAUAYAN COLLEGE 2015 2020 2020
MAJOR IN MATHEMATICS

GRADUATE STUDIES N/A

SIGN ATURE
CS FORM 212 (Revised 2017), Page 1 of
(Continue on
separate sheet if
necessary) DATE MAY
9,
2023

CS FORM 212 (Revised 2017), Page 2 of

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
SPECIAL LAWS/ CES/ CSEE RATING EXAMINATION / Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Validity

LICENSURE EXAMINATION FOR TEACHERS 83.2 10.02.2022 MANILA 1966268

08.10.2026
6509-7217-
PHILIPPINE NATIONAL IDENTIFICATION
4316-3824
DRIVER'S LICENSE 05.09.2019 IBA, CITY OF MEYCAUAYAN, BULACAN C08-19-004620
06.10.2023

(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.
INCLUSIVE DATES SALARY/ JOB/
28.
PAY GRADE (if
(mm/dd/yyyy) applicable)& STEP GOV'T
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(Format "00-0")/ SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) MONTHLY STATUS OF
From To INCREMENT (Y/ N)
SALARY APPOINTMENT
SENIOR HIGH SCHOOL MATHEMATICS JESUS IS LORD COLLEGES
06/24/2021 05/31/2023 PERMANENT NO
TEACHER FOUNDATION, INC. ₱ 16,125.00
JUNIOR HIGH SCHOOL MATHEMATICS JESUS IS LORD COLLEGES
08/28/2020 06/23/2021 PERMANENT NO
TEACHER FOUNDATION, INC. ₱ 15,500.00
10/-/2017 01/-/2018 PART TIME TUTOR THE PEDAGOGUE TUTORING CENTER CASUAL NO
₱ 4,500.00

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 3 of

SIGNATURE DATE MAY 9, 2023

CS FORM 212 (Revised 2017), Page 4 of

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)
POSITION / NATURE OF WORK
From To
NUMBER OF HOURS

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
(Write in full) (mm/dd/yyyy) ( Managerial/
Supervisory/ CONDUCTED/ SPONSORED BY
From To Technical/etc) (Write in full)

COMPUTER LITERACY 01/23/2023 02.10.2023 90 TECHNICAL CSLC SEMINAR AND TUTORIAL CENTER

JILCF IN-SERVICE TRAINING 2022: BE UNWAVERING COURAGE: BE F.I.R.M ( FOCUSED,

08.02.2022 08.03.2022 12 TECHNICAL JESIS IS LORD COLLEGES FOUNDATION
INNOVATIVE, RESILIENT, MOTIVATING)
PEAC 2022 INSET for Senior High School Teachers: Adaptive (Flexible) Teaching of SHS PRIVATE EDUCATION
07/21/2022 07/23/2022 27 TECHNICAL
Core Subjects Towards Optimal Learning ASSISTANCE
COMMITTEE
JILCF IN-SERVICE TRAINING 2020: READY FOR TAKE OFF, READY TO SOAR 08.04.2021 08.04.2021 6 TECHNICAL JESIS IS LORD COLLEGES FOUNDATION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
32. 33.
31. SPECIAL SKILLS and HOBBIES (Write in full) (Write in full)

PHILIPPINE ASSOCIATION FOR TEACHERS

BEAUTY CARE ROOKIE OF THE YEAR
AND EDUCATORS
COMPUTER LITERATE MOST INNOVATIVE

MOST EFFICIENT

ASSISTANT ACADEMIC COORDINATOR (OIC) - SHS MATHEMATICS DEPARTMENT

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 5 of

SIGNATURE DATE MAY 9, 2023

CS FORM 212 (Revised 2017), Page 6 of

 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?
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO

YES NO
If YES, give details:
35. a. Have you ever been found guilty of any administrative offense? YES NO
If YES, give details:

YES NO
b. Have you been criminally charged before any court? 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
b.
Are you a person with disability? If YES, please specify:
YES NO
c.
Are you a solo parent? If YES, please specify ID No:
YES NO

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

MRS. MARIA CECILIA GERONIMO-BERNARDINO MARILAO, BULACAN 0928-318-6286

ID picture taken within
MRS. JOCELYN GRAFE-COLOBONG BOCAUE, BULACAN 0933-629-2797 the last 6 months
4.5 cm. X 3.5 cm
(passport size)
ENGR. EDGARDO CARBILLEDO BOCAUE, BULACAN 0969-609-0642

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. is not acceptable
I agree that any misrepresentation made in this document and its attachments shall cause the 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.: 1966268 Signature (Sign inside the box)

MAY 9, 2023
Date/Place of Issuance: 02/23/2023
Date Accomplished

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

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

 WORK EXPERIENCE SHEET
 Instructions: 1. Include only the work experiences relevant to the position being applied for.

2. The duration should include start and finish dates, if known, month in abbreviated
form, if known, and year in full. For the current position, use the word Present, e.g.,
1998-Present. Work experience should be listed starting with the most recent/present
employment

 Duration: June 24, 2021 – May 31, 2023

 Position: Senior High School Mathematics Teacher/ Assistant Academic Coordinator – SHS
Mathematics Department
 Name of Office/Unit: Senior High School Department
 Immediate Supervisor: Engr. Edgardo Z. Carbilledo
 Name of Agency/Organization and Location: Jesus Is Lord Colleges Foundation, Inc. –
Bunlo, Bocaue, Bulacan

 List of Accomplishments and Contributions (if any)

 Summary of Actual Duties

o In charge of the strict supervision of the Senior High School Mathematics Teacher;
coordinates school programs, rules, and directives.
o In charge of preparing and carrying out the department's plans for the school year.
Responsible for creating and collating all departmental reports.
o Teach Mathematics 10, General Mathematics, Statistics and Probability, and
Entrepreneurship subject to Grade 11 and Empowerment Technology subject to
Grade 12.
o Develops lesson plans, enables functional lesson plans, starts student discipline,
monitors attendance, classroom management, monitors students' progress,
conducts remediation, holds periodic PTA meetings, prepares the exam and table
of specifications, and attends faculty meetings.

  Duration: August 28, 2020 – June 23, 2021

 Position: Junior High School Mathematics Teacher
 Name of Office/Unit: Junior High School Department
 Immediate Supervisor: Celia Romano
 Name of Agency/Organization and Location: Jesus Is Lord Colleges, Foundation, INC. –
Bunlo, Bocaue, Bulacan

 List of Accomplishments and Contributions (if any)

 Summary of Actual Duties

o Teach Mathematics 8.
o Develops lesson plans, enables functional lesson plans, starts student discipline,
monitors attendance, classroom management, monitors students' progress,
conducts remediation, holds periodic PTA meetings, prepares the exam and table
of specifications, and attends faculty meetings.

Attachment to CS Form No. 212

MONESSE ANGELA A. MONTEMAYOR, LPT

(Signature over Printed Name of Employee/Applicant)
Date: May 9, 2023