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 BARDON
FIRST NAME AIZA
MIDDLE NAME ABRAHAM
3. DATE OF BIRTH
(mm/dd/yyyy) 08/21/1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
4. PLACE OF BIRTH MALATAP, LABO CAMNORTE If holder of dual citizenship, Pls.birth
indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed Separated House/Block/Lot No. Street
P-2 BULHAO
Other/s:
Subdivision/Village Barangay
LABO CAMARINES NORTE
7. HEIGHT (m) 152
City/Municipality Province
8. WEIGHT (kg) 85 ZIP CODE 4604
18. PERMANENT ADDRESS
9. BLOOD TYPE 0
House/Block/Lot No. Street

10. GSIS ID NO. 011169175930 P-2 BULHAO

Subdivision/Village Barangay
11. PAG-IBIG ID NO. 121195229619 LABO CAMARINES NORTE
City/Municipality Province
12. PHILHEALTH NO. 10025244021 ZIP CODE 4604
13. SSS NO. 210980280597 19. TELEPHONE NO. N/A
14. TIN NO. 473814978 20. MOBILE NO. 09098652401
15. AGENCY EMPLOYEE NO. 6315045 21. E-MAIL ADDRESS (if any) aizabardon1@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BARDON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
N/A ALJUN A. BARDON
FIRST NAME ALVIN 11/18/2009
MIDDLE NAME GALVEZ ZHOREN GAB A. BARDON 08/19/2017
OCCUPATION LEGISLATIVE OFFICER/ MUN. VICE MAYOR ALWIN ROY A. BARDON 7/5/2019
EMPLOYER/BUSINESS NAME LOCAL GOVERNMENT UNIT AIZABELLE A. BARDON 04/13/2022
BUSINESS ADDRESS LABO, CAMNORTE
TELEPHONE NO. N/A
24. FATHER'S SURNAME ABRAHAM
FIRST NAME RODEL N/A

MIDDLE NAME VECINO

25. MOTHER'S MAIDEN NAME

SURNAME ESPAÑOL
FIRST NAME SHIRLEY
MIDDLE NAME GARCIA (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

ELEMENTARY MALATAP ELEMENTARY SCHOOL ELEMENTARY 1999 2005 GRADUATED 2005 VALEDICTORIAN

SECONDARY /
VOCATIONAL DAGUIT NATIONAL HIGH SCHOOL HIGH SCHOOL 2005 2009 GRADUATED 2009

LCSTC VOCATIONAL 2009 2009 NC II 2009

TRADE
BACHELOR OF ELEMENTARY
COURSE
COLLEGE CAMARINES NORTE COLLEGE 2009 2015 GRADUATED 2015
EDUCATION
MASTER IN EDUCATION, MAJOR IN
GRADUATE STUDIES MABINI COLLEGES EDUCATIONAL LEADERSHIP
7/10/1905 7/10/1905 10 UNITS N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 30, 2023

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
DATE OF LICENSE (if applicable)
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) RATING
EXAMINATIO
UNDER SPECIAL LAWS/ CES/ CSEE (If
N/ PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / Applicabl NUMBER Date of
CONFERMEN
DRIVER'S LICENSE e) Validity
T
LICENSURE EXAMINATION FOR
78.0 4/1/2017 LUCENA 1393938 08/21/24
TEACHER

(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
SERVICE
28. INCLUSIVE DATES DEPARTMENT / AGENCY / SALARY/ JOB/
(mm/dd/yyyy) POSITION TITLE PAY GRADE (if STATUS OF
OFFICE / COMPANY
MONTHLY applicable)&
APPOINTME
(Write in SALARY STEP (Format
(Write in full/Do not "00-0")/ NT
From To full/Do not abbreviate) INCREMENT
abbreviate)
(Y/
N)
DON MIGUEL LUKBAN SG 11,
07/24/2018 PRESENT TEACHER 1
ELEMENTARY SCHOOL
25723.00
STEP 2
PERMANENT Y

SAINT JOHN APOSTLE

03/06/2015 04/25/2017 ELEMENTARY TEACHER
ACADEMY
7000.00 JOB ORDER N

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 30, 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 HOURS POSITION / NATURE OF WORK
(Write in full) (mm/dd/yyyy)
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) Technical/etc)
From To

Performance Management System(RPMS) Manual

Teacher
08/24/2018 08/26/2018 40 Managerial Department of Education

5 days School Based Training-Workshop on Capacity

Building & Pedagogy Based on least learned Skills & 10/21/2019 10/25/2019 40 Managerial Department of Education
Preparation on Instructional Materials

Division Online Training for Elementary Music and

08/25/2021 08/27/2021 24 Department of Education
Arts Teacher 2021
Virtual Inset 2021 08/30/2021 3/9/2021 40 Managerial Department of Education
2NS Virtual Inset 03/15/2021 03/19/2021 40 Managerial Department of Education
School Based Learning Action Cel (LAC) for Tearcher FEB. 2021 05/21/2021 40 Managerial Department of Education
5-Days School Based in Service Training for Teacher
(INSET)
01/31/2022 5/2/2022 40 Managerial Department of Education

5-Days School Based in Service Training for Teacher

(INSET)
6/2/2023 10/2/2023 40 Managerial Department of Education

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 30, 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: ________________________________

________________________________
YES ✘ NO
b. Have you been criminally charged before any court?
If YES, give details: ________________________________
________________________________
Date Filed:
Status of Case/s:
YES ✘ NO
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
by any court or tribunal?
If YES, give details: ________________________________
________________________________
YES ✘ NO
37. Have you ever been separated from the service in any of the following modes: resignation,
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? ________________________________
YES ✘ NO
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES If YES, give
✘ details:
NO

b. Have you resigned from the government service during the three (3)-month period before the last
election to promote/actively campaign for a national or local candidate? YES If YES, give
✘ details:
NO

39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
YES ✘ NO
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?
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
WILMA M. OJEDA TULAY NA LUPA, LABO, CN 91944006279 the last 6 months
3.5 cm. X 4.5 cm
JOSEPH V. ASCUTIA SAN FRANCISCO, LABO, CN 9189035226 (passport size)

EVARISTO GODOFREDO L. PANDI BAUTISTA, LABO, CN 9982470988 With full and handwritten
name tag and signature over
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and printed name
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Computer generated
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. or photocopied picture
is not acceptable
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/License/Passport No.: 1393935

Signature (Sign inside the box)

Date/Place of Issuance: 12/09/2024

MARCH 30, 2023
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