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 MAGLAYA
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARIA JESUSA
MIDDLE NAME DUMLAO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/13/1996 ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH QUEZON 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 121 PAJO STREET
Widowed Separated House/Block/Lot No. Street

Other/s:
N/A BARANGAY QUIRINO 2-B
Subdivision/Village Barangay
7. HEIGHT (m) 1.676m QUEZON CITY METRO MANILA
City/Municipality Province
8. WEIGHT (kg) 60kg ZIP CODE 1102

9. BLOOD TYPE O
18. PERMANENT ADDRESS BLOCK 91 LOT 25 N/A
House/Block/Lot No. Street
10. GSIS ID NO. N/A PHASE 1 BARANGAY PINUGAY
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-0603-5801 BARAS RIZAL

City/Municipality Province

12. PHILHEALTH NO. 03-02616716-6 ZIP CODE 1970

13. SSS NO. 3-6335175-9 19. TELEPHONE NO. N/A

14. TIN NO. 512-655-128 20. MOBILE NO. 0922-9781363

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) mariajesusamaglaya@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 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 MAGLAYA
NAME EXTENSION (JR., SR)
FIRST NAME EFREN N/A

MIDDLE NAME BACALZO

25. MOTHER'S MAIDEN NAME

SURNAME DUMLAO
FIRST NAME JULIANA
MIDDLE NAME AGRA (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 PROJECT 3 ELEMENTARY SCHOOL PRIMARY EDUCATION 2003 2009 GRADUATED 2009 N/A

SECONDARY /
VOCATIONAL QUIRINO HIGH SCHOOL HIGH SCHOOL 2009 2013 GRADUATED 2013 N/A

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

TRADE
BACHELOR OF SECONDARY
COURSE
COLLEGE NEW ERA UNIVERSITY 2013 2017 GRADUATED 2017 N/A
EDUCATION MAJOR IN ENGLISH

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

LICENSURE EXAMINATION FOR TEACHERS 77.20 01/09/2017 MANILA 1617076 01/22/2022

(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)
CONTRACTUA
06/04/2019 12/20/2021 TEACHER GENIUS KIDS LEARNING CENTER 13,000.00 N/A N
L
CONTRACTUA
06/01/2017 04/15/2019 TEACHER STARLAND INTERNATIONAL SCHOOL 13,000.00 N/A N
L
 (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

NEW ERA UNIVERSITY - SUMMER PRE-KINDER GARTEN PROGRAM 04/14/2014 05/23/2014 30 ASSISTANT TEACHER

NEW ERA UNIVERSITY - ALTERNATIVE LEARNING SERVICE 08/11/2014 11/28/2014 75 ASSISTANT TEACHER

NEW ERA UNIVERSITY - SUMMER PRE-KINDER GARTEN PROGRAM 04/15/2019 05/30/2019 34 TEACHER

(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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

BUCKLE UP: CREATING A SAFE SPACE FOR HOME BASED LEARNING 06/15/2020 06/15/2020 1.5 FOUNDATIONAL REX ACADEMY

TEACHING COLLABORATIVE WRITING IN ONLINE DISTANCE LEARNING 06/13/2020 06/13/2020 1.5 FOUNDATIONAL REX ACADEMY

UTILIZATION AND DEVELOPMENT OF E-BOOKS USING KETOBEE AUTHOR 06/10/2020 06/10/2020 3 FOUNDATIONAL DEPARTMENT OF EDUCATION
MAXIMIZING THE EDGE: TRANSFORMING EDUCATIONAL PEDAGOGY THROUGH LEADERSHIP IN EDUCATION ACADEMY AND
RESEARCH INNOVATIONS AND IMPLICATIONS
01/31/2020 02/02/2020 24 FOUNDATIONAL
DEVELOPMENT
STREAMLINING THE 21ST CENTURY CLASSROOMS WITH EFFECTIVE TEACHING ST. AUGUSTINE PUBLICATIONS,
STRATEGIES
05/29/2019 05/29/2019 8 FOUNDATIONAL
INCORPORATED
CENTER FOR HUMAN RESEARCH AND DEVELOPMENT
NATIONAL SEMINAR WORKSHOP ON DIGITAL CITIZENSHIP 02/23/2018 02/24/2018 24 FOUNDATIONAL
FOUNDATION, INCORPORATED

IN-CAMPUS PRACTICE TEACHING IN QUEZON CITY HIGH SCHOOL 11/28/2016 03/10/2017 200 FOUNDATIONAL NEW ERA UNIVERSITY
PHILIPPINE ASSOCIATION FOR TEACHERS
UNDERSTANDING CREATIVITY: A 21ST CENTURY SKILLS 09/03/216 09/03/2016 8 FOUNDATIONAL
AND EDUCATORS
PRACTICE TEACHING 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

TEACHING AND LEARNING FOR THE MILLENIALS 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

GOOD GROOMING FOR STUDENT TEACHERS 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

TASK/TIME MANAGEMENT 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

STUDY AND THINKING SKILLS FOR FUTURE TEACHERS 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

CLASSROOM MANAGEMENT 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

USING TECHNOLOGY FOR EFFECTIVE TEACHING 07/09/2016 07/09/2016 8 FOUNDATIONAL NEW ERA UNIVERSITY

IN-CAMPUS PRACTICE TEACHING IN NEW ERA UNIVERSITY INTEGRATED SCHOOL 07/04/2016 10/18/2016 200 FOUNDATIONAL NEW ERA UNIVERSITY

(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)

TEACHING SKILLS N/A N/A

HIGH ORDER THINKING SKILLS

 CLASSROOM MANAGEMENT

COMPUTER AND TECHNOLOGY LITERATE

COMPASION AND EMPATHY

SUBJECT EXPERTISE

TIME MANAGEMENT
(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:

________________________________
N/A

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
N/A
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed: N/A
________________________________
Status of Case/s: N/A

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:
________________________________
N/A
________________________________
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? ________________________________
N/A
________________________________
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: N/A

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: N/A
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):
N/A
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: N/A
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No: N/A
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No: N/A

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

NAME ADDRESS TEL. NO.

ID picture taken within
276 P. GOMEZ ST. 10TH AVENUE, CALOOCAN the last 6 months
ABIGAIL O. ABERIN CITY
9456720085 3.5 cm. X 4.5 cm
(passport size)
146 DOCE STREET EAST BAGONG BARRIO,
ARNELL MARTIN CALOOCAN CITY
9972012997 With full and handwritten
name tag and signature over
printed name
MARIEL TAGUIBAO 41 JASMIN STREET PAYATAS A, QUEZON CITY 9561343311
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: PROFESSIONAL REGULATION COMMISSION

ID/License/Passport No.: 1617076 Signature (Sign inside the box)

Date/Place of Issuance: 01/22/2018/MANILA Date Accomplished Right Thumbmark

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

MARICRIS S. SANTOS
Principal IV
Person Administering Oath

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