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 IBARRA
NAME EXTENSION (JR., SR)
FIRST NAME EUGENE LOUIE

MIDDLE NAME GIMARINO

3. DATE OF BIRTH
SEPTEMBER 21,1988 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘ by birth✘ by naturalization

4. PLACE OF BIRTH LOMUYON, KIAMBA SARANGANI PROVINCE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female Philippines
6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS N/A PUROK EVERLASTING
Widowed Separated House/Block/Lot No. Street
N/A LOMUYON
Other/s: Subdivision/Village Barangay
KIAMBA SARANGANI
7. HEIGHT (m) 1.59 CM
City/Municipality Province

8. WEIGHT (kg) 76 KGS ZIP CODE 9514

18. PERMANENT ADDRESS N/A PUROK EVERLASTING
9. BLOOD TYPE O
House/Block/Lot No. Street

10. GSIS ID NO. 0200-5440-773 N/A LOMUYON

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-3331-1871 KIAMBA SARANGANI

City/Municipality Province

12. PHILHEALTH NO. 1705-0200-2980 ZIP CODE 9514

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 728-532-015 20. MOBILE NO. O915-7603-680

15. AGENCY EMPLOYEE NO. 4928434 21. E-MAIL ADDRESS (if any) eugenelouieibarra31@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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME IBARRA

NAME EXTENSION (JR., SR)
FIRST NAME RICHARD

MIDDLE NAME LAYAGUIN

25. MOTHER'S MAIDEN NAME

SURNAME GIMARINO

FIRST NAME ESTRELLA

MIDDLE NAME BAGAAN (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 LOMUYON ELEMENTARY SCHOOL ELEMENTARY SCHOOL 1994 2000 GRADUATED 2000 N/A

SECONDARY
VOCATIONAL / KLING NATIONAL HIGH SCHOOL SECONDARY SCHOOL 2001 2005 GRADUATED 2005 N/A

JAMES L. CHIONGBIAN NATIONAL TRADE

FOOD PROCESSING NC II 5/16/2016 11/26/2016 COMPLETED 2016 N/A
SCHOOL
TRADE BACHELOR OF SECONDARY
COURSE GENSANTOS FOUNDATION COLLEGE
COLLEGE EDUCATION MAJOR IN ENGLISH 6/17/2011 3/28/2015 GRADUATED 2015 N/A
INC.
RAMON MAGSAYSAY MEMORIAL MASTER OF ARTS IN EDUCATION
GRADUATE STUDIES 9/27/2018 12/10/2018 9 UNITS
COLLEGES MAJOR IN ENGLISH
(Continue on separate sheet if necessary)

SIGNATURE DATE January 20, 2023

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Date of
Validity
UNIVERSITY OF MINDANAO, MATINA DAVAO
RA 1080 77.00% 9/27/2015 1440580 9/21/2019
CITY

(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. SERVICE
INCLUSIVE DATES SALARY/ JOB/ PAY
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)
DepEd/Division of Sarangani (Bongo
01/ 16/2023 PRESENT TEACHER 1 27, 284.00 11-2 PERMANENT Y
Integrated School)
DepEd/Division of Sarangani (Bongo
10/25/2021 12/31/2022 TEACHER 1 26,161.00 11-2 PERMANENT Y
Integrated School)
DepEd/Division of Sarangani (Bongo
9/19/2020 10/25/2021 TEACHER 1 25,877.00 11-1 PERMANENT Y
Integrated School)
DepEd/Division of Sarangani (Bongo
8/1/2018 8/19/2019 TEACHER 1 20,754.00 11-1 PERMANENT Y
Integrated School)

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 20, 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
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

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
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

ENHANCE SCHOOL IMPROVEMENT PLAN (ESIP) 11/18/2022 11/25/2022 8 TECHNICAL DEPED-DISTICT OFFICE

SEMINAR-WORKSHOP ON CONTENT, PEADAGOGY & ASSESSMENT ACROSS

8/18/2022 8/19/2022 30 TECHNICAL DEPED-SARANGANI
ALL LEARNING AREAS

AUDIO RECORDING AND EDITING WORKSHOP 8/26/2021 8/26/2021 8 TECHNICAL DEPED-DISTICT OFFICE
Online Training on Learning Delivery of K to 12 Basic Education Curriculum Content,
07/17/2020 07/17/2020 4 TECHNICAL DEPED-SARANGANI
Pedagogy and Assessment (CPA) for Technology and Livelihood in the New Normal
Webinar and Orientation of Rationale and Design of the Most Essential Learning
07/13/2020 07/13/2020 4 TECHNICAL DEPED-SARANGANI
Competencies in Araling Panlipunan for School Heads and Teachers in Sarangani

Webinar and Orientation of Rationale and Design of the Most Essential Learning
07/10/2020 07/10/2020 4 TECHNICAL DEPED-SARANGANI
Competencies in English for School Heads and Teachers in Sarangani

Webinar and Orientation of Rationale and Design of the Most Essential Learning
07/10/2020 07/10/2020 4 TECHNICAL DEPED-SARANGANI
Competencies in Filipino for School Heads and Teachers in Sarangani

Webinar and Orientation of Rationale and Design of the Most Essential Learning
07/8/2020 07/8/2020 4 TECHNICAL DEPED-SARANGANI
Competencies in Science for School Heads and Teachers in Sarangani

LDM2 COURSE FOR TEACHERS 10/12/2020 10/12/2020 40 TECHNICAL BONGO INTEGRATED SCHOOL

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

SINGING N/A N/A

COOKING

READING INSPIRATIONAL BOOKS

LETTERING

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 20, 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:
________________________________
________________________________
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? ________________________________
________________________________
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
1/20/2023
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
3.5 cm. X 4.5 cm
SEGUIL, BAWING, GENERAL SANTOS (passport size)
MATEO L. GULAC CITY.
9974386563
With full and handwritten
name tag and signature over
printed name

Computer generated
or photocopied picture
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: GSIS UMID
ID/License/Passport No.: 021-1948-5535-1 Signature (Sign inside the box)
JANUARY 20, 2023
Date/Place of Issuance: 09/28/2019/GENERAL SANTOS 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