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 CAMPANILLA
NAME EXTENSION (JR., SR) N/A
FIRST NAME GERALD

MIDDLE NAME TANGKAY

3. DATE OF BIRTH
06/18/1986 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by birth
4. PLACE OF BIRTH CEBU CITY If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX ✘ Male Female
17. RESIDENTIAL ADDRESS 216 P. NELLAS STREET
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separate BARANGAY POBLACION III
Other/s: d Subdivision/Village Barangay
CARCAR CITY CEBU
7. HEIGHT (m) 1.67
City/Municipality Province
8. WEIGHT (kg) 85 ZIP CODE 6019

18. PERMANENT ADDRESS 216 P. NELLASV STREET

9. BLOOD TYPE O+
House/Block/Lot No. Street
BARANGAY POBLACION III
10. GSIS ID NO. 2004282450
Subdivision/Village Barangay
CARCAR CITY CEBU
11. PAG-IBIG ID NO. 1210-8386-4786
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 6019

12-000115844-4
13. SSS NO. N/A 19. TELEPHONE NO. 487-0132

14. TIN NO. 424-388-127-000 20. MOBILE NO. +639674332477

15. AGENCY EMPLOYEE NO. 4650049 21. E-MAIL ADDRESS (if any) gerald.campanilla@deped.gov.ph
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) N/A
FIRST NAME N/A
N/A
MIDDLE NAME N/A
N/A
OCCUPATION N/A
N/A
EMPLOYER/BUSINESS NAME N/A
N/A
BUSINESS ADDRESS N/A
N/A
TELEPHONE NO. N/A
N/A
24. FATHER'S SURNAME CAMPANILLA
NAME EXTENSION (JR., SR) JR. N/A
FIRST NAME WOLFRANDO
N/A
MIDDLE NAME ARAGON
N/A
25. MOTHER'S MAIDEN NAME TANGKAY
N/A
SURNAME CAMPANILLA
N/A
FIRST NAME JEANNY

MIDDLE NAME NAVEO (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 CARCAR CENTRAL SCHOOL BASIC EDUCATION 1/6/1993 03/15/1999 1999

SECONDARY /
VOCATIONAL CARCAR CENTRAL NATIONAL HIGH SCHOOL BASIC EDUCATION 1/6/1999 11/4/2003 2003

TRADE
COURSE
COLLEGE CEBU TECHNOLOGICAL UNIVERSITY BACHELOR IN SECONDARY EDUCATION 1/6/2003 03/15/2007 2007 CUM LAUDE

GRADUATE STUDIES UNIVERSITY OF CEBU GRADUATE DIPLOMA IN TEACHING ARTS 1/5/2021 5/12/2021 24 2021 PCEP-NCCA

GRADUATE STUDIES CEBU TECHNOLOGICAL UNIVERSITY MASTER OF ARTS IN VOCATIONAL EDUCATION 1/5/2023 PRESENT 12

(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
MARCH 15,
CIVIL SERVICE ELIGIBILITY APRIL 02, 2007 CEBU CITY 10072384 2007
JUNE 18,
LICENSURE EXAMINATION FOR TEACHERS 75.2 AUGUST 26, 2007 CEBU CITY 0974606 2025
JUNE 18,
DRIVER'S LICENSE CARCAR CITY G09-15-001216 2032

(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)
LOCAL SCHOOL
8/6/2008 1/31/2013 TEACHER LGU-CARCAR CITY 7500.00
BOARD
YES
REGULAR
1/2/2013 PRESENT TEACHER I DEPED-CARCAR CITY 27865.00 SG 11 STEP 4 /PERMANENT YES

(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

KOREA-PHILIPPINES FESTIVAL AND CULTURAL EXCHANGE ASSOCIATION 11/15/2022 PRESENT MEMBER

(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

IN SERVICE TRAINING 6/2/2023 10/2/2023 40.0 TECHNICAL DEPED CARCAR CITY DIVISION

IN SERVICE TRAINING 1/2/2022 5/2/2022 40.0 TECHNICAL DEPED CARCAR CITY DIVISION

NATIONAL FOLK DANCE WORKSHOP 4/8/2021 5/8/2021 16.0 TECHNICAL PHILIPPINE NATIONAL FOLK DANCE SOCIETY

INSERVICE TRAINING 12/14/2020 12/19/2020 40.0 TECHNICAL DEPED CARCAR CITY DIVISION

GAD INTEGRATED MID-YEAR INSERVINCE TRAINING 10/21/2019 10/25/2019 40.0 TECHNICAL DEPED CARCAR CITY DIVISION

39TH NATIONAL FOLK DANCE WORKSHOP 05/20/2019 05/24/2019 50.0 TECHNICAL PHILIPPINE NATIONAL FOLK DANCE SOCIETY

(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 SKILLS WINNING COACH IN VOLLEYBALL AND CULTURE AND ARTS PHILIPPINE FOLK DANCE SOCIETY

DANCING SKILLS/CHOREOGRAPHY GIFTS OF CARCAR CITY

CHOREOGRAPHERS ASSOCIATION IN CEBU

KOREA-PHILIPPINES FESTIVAL AND
CULTURAL EXCHANGE ASSOCIATION

(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
by any court or tribunal? YES ✘ NO
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
DR. EDEL BRYAN M. BARDINAS CAMBUNTAN, CARCAR CIRY, CEBU 9773413758 4.5 cm. X 3.5 cm
(passport size)

DR. KATHRYN Q. ESTENZO POBLACION I, CARCAR CITY, CEBU 9279832935

Computer generated
BARANGAY POBLACION I, CARCAR CITY, or photocopied picture
MR. PHILIP REY NACARIO CEBU
9164448025 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/License/Passport No.: 0974606

Signature (Sign inside the box)

Date/Place of Issuance: CEBU 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