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 MACALINTAL
NAME EXTENSION (JR., SR) N/A
FIRST NAME MYLA

MIDDLE NAME VALENCIA

3. DATE OF BIRTH
(mm/dd/yyyy) 05/09/1997 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH CASTILLO, PADRE GARCIA, BATANGAS If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS N/A N/A

Widowed House/Block/Lot No. Street

Separate
N/A CASTILLO
Other/s: d
Subdivision/Village Barangay

7. HEIGHT (m) 147.5 PADRE GARCIA BATANGAS

City/Municipality Province
8. WEIGHT (kg) 37.1 kg ZIP CODE 4224

18. PERMANENT ADDRESS N/A N/A

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A CASTILLO
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A PADRE GARCIA BATANGAS

City/Municipality Province

12. PHILHEALTH NO. 092507615963 ZIP CODE 4224

13. SSS NO. 04-4237720-7 19. TELEPHONE NO. N/A

14. TIN NO. 747-617-477-000 20. MOBILE NO. 09266056098

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) myluvers09@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) N/A N/A
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 MACALINTAL

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

MIDDLE NAME DIN

25. MOTHER'S MAIDEN NAME

SURNAME VALENCIA

FIRST NAME MARCOSA

MIDDLE NAME MONTEMAYOR (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 CASTILLO ELEMENTARY SCHOOL ELEMENTARY 3/6/2003 03/31/2009 N/A 2009 N/A

SECONDARY /
VOCATIONAL PANSOL NATIONAL HIGH SCHOOL HIGH SCHOOL 5/6/2009 03/22/2013 N/A 2013 N/A

N/A N/A N/A N/A N/A N/A N/A

TRADE
COURSE
COLLEGE KOLEHIYO NG LUNGSO NG LIPA BACHELOR OF ELEMENTARY EDUCATION 06/22/2014 05/23/2018 N/A 2018 N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A 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

LET ( LICENSURE EXAMINATION FOR TEACHERS) 80.0 09/30/2018 LUCENA CITY 1690148 9/5/2024

Nothing Follows

(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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)
08/26/2022 11/15/2022 SUBSTITUTE TEACHER BUKAL ELEMENTARY SCHOOL P25 439 11 SUBSTITUTE Y
DOMINGO M. ZUÑO ELEMENTARY
05/18/2022 07/01/2022 SUBSTITUTE TEACHER P 25 439 11 SUBSTITUTE Y
SCHOOL
1/12/2021 12/17/2021 SUBSTITUTE TEACHER PANSOL ELEMENTARY SCHOOL P 23 877 11 SUBSTITUTE Y

11/08/2021 11/30/2021 SUBSTITUTE TEACHER PANSOL ELEMENTARY SCHOOL P 23 877 11 SUBSTITUTE Y

10/11/2021 10/31/2021 SUBSTITUTE TEACHER PANSOL ELEMENTARY SCHOOL P 23 877 11 SUBSTITUTE Y

05/27/2021 09/01/2021 SUBSTITUTE TEACHER BAWI ELEMENTARY SCHOOL P 23 877 11 SUBSTITUTE Y

01/04/2021 03/04/2021 SUBSTITUTE TEACHER TANGOB ELEMENTARY SCHOOL P 22 316 11 SUBSTITUTE Y

11/26/2020 12/18/2020 SUBSTITUTE TEACHER TANGOB ELEMENTARY SCHOOL P 22 316 11 SUBSTITUTE Y

02/03/2020 04/02/2020 SUBSTITUTE TEACHER BAWI ELEMENTARY SCHOOL P 22 316 11 SUBSTITUTE Y

08/01/2019 11/07/2019 SUBSTITUTE TEACHER COLONGAN ELEMENTARY SCHOOL P 20 754 11 SUBSTITUTE Y

Nothing Follows

(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

L
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a
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n
(Continue on separate sheet if necessary)
i
nVII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
g(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
t
30.TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS
ATTENDANCE Type of LD
( Managerial/ CONDUCTED/ SPONSORED BY
o (Write in full)
NUMBER OF HOURS
Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
l
e2019 Cluster-based-In-Service Training and Workshop on Test 10/23/2019 10/25/2019 24.0 Supervisory Rosario West District
Construction,
a ICT Utilization and Conduct of Action Research
rAgricultural Productions NC II 07/08/2019 10/12/2019 282.0 Supervisory
n MOCA family farm Rlearning Center

Agricultural Crops Production NC I 04/22/2019 06/19/2019 302.0 Supervisory MOCA Family Farm Rlearning Center
a
bAgroentrepreneurship NC II 01/15/2019 01/19/2019 24.0 Supervisory
ATI / ITCPH
o
vOrganic Agricultural Production NC II 11/19/2018 12/12/2018 232.0 Supervisory
MOCA family farm Rlearning Center
e
Nothing Follows
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(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)

good communication skills N/A N/A

leadership

computer literate

critical thinking and problem solving

Nothing follows

(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 ✘ 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 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? END OF CONTRACT
________________________________
________________________________
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
Mary ann M. Lopez Ed.d Tangob, Padre Gracia, Batangas 9463729985 3.5 cm. X 4.5 cm
(passport size)

Isabel M. Manalo Castillo, Padre Garcia, Batangas 9276113745 With full and handwritten
name tag and signature over
printed name
Nicetas B. Amante Castillo, Padre Garcia, Batangas 917722179
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 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.: 1690148

Signature (Sign inside the box)

Date/Place of Issuance: 12/27/2018/ LUCENA CITY

Date Accomplished Right Thumbmark

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

LOU C. PANALIGAN
Person Administering Oath

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