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 CAONES
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARY ANN

MIDDLE NAME PARADO

3. DATE OF BIRTH
(mm/dd/yyyy) 07/30/1986 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH BURAUEN LEYTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS SITIO MALITBOG/DISTRICT 3

Widowed Separated House/Block/Lot No. Street

Other/s:
Subdivision/Village Barangay
BURAUEN LEYTE
7. HEIGHT (m) 1.252
City/Municipality Province
8. WEIGHT (kg) 49KG ZIP CODE 6516

18. PERMANENT ADDRESS SITIO MALITBOG DISTRICT 3

9. BLOOD TYPE "O"
House/Block/Lot No. Street
10. GSIS ID NO. 000-6286-2670-1
Subdivision/Village Barangay
BURAUEN LEYTE
11. PAG-IBIG ID NO. 917070343074
City/Municipality Province

12. PHILHEALTH NO. 13-025246608-9 ZIP CODE 6516

13. SSS NO. 0006-2862670-1 19. TELEPHONE NO. NONE

14. TIN NO. 275-928-183-000 20. MOBILE NO. 09855853513

15. AGENCY EMPLOYEE NO. 4662507 21. E-MAIL ADDRESS (if any) maryann.caones@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CAONES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

AIAN NAME EXTENSION (JR., SR)

FIRST NAME AIANHA MAE P. CAONES 7/2/2015

MIDDLE NAME DACA IAN DAVE P. CAONES 05/14/2016

OCCUPATION UTILITY WORKER

EMPLOYER/BUSINESS NAME LOCAL GOVERNMENT UNIT BURAUEN

BUSINESS ADDRESS BURAUEN LEYTE

TELEPHONE NO. NONE

24. FATHER'S SURNAME PARADO

FAUSTINO NAME EXTENSION (JR., SR)

FIRST NAME

MIDDLE NAME LEONA

25. MOTHER'S MAIDEN NAME ERLINDA AGRAVA NABOYA

SURNAME PARADO

FIRST NAME ERLINDA

MIDDLE NAME NABOYA (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
 NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY PUSOD ELEMENTARY SCHOOL PRIMARY EDUCATION GRAUATED 2000 N/A

BURAUEN COMPREHENSIVENATIONAL HIGH

SECONDARY
VOCATIONAL / SCHOOL
HIGH SCHOOL GRAUATED 2004 N/A

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

TRADE
COURSE
COLLEGE LEYTE NORMAL UNIVERSITY BACHELOR OF ELEMENTARY EDUCATION GRAUATED 2008 N/A

GRADUATE STUDIES ASIAN DEVELOPMENT FOUNDATION COLLEGE MASTER OF ARTS EDUCATION 36 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 01/19/2023

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

BOARD OF PROFESSIONAL TEACHERS 75.2 MARCH 12, 2012 SAGKAHAN BLISS TACLOBAN CITY 1136677 07/30/22

(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)
DEPARTMENT OF EDUCATION LEYTE REGULAR/
1/1/2023 PRESENT ELEMENTARY GRADE TEACHER III 26012.00 STEP 3 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
8/24/2022 12/31/2022 ELEMENTARY GRADE TEACHER III 26012.00 STEP 3 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
1/1/2021 8/23/2022 ELEMENTARY GRADE TEACHER I 24161.00 STEP 2 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
1/1/2020 12/31/2020 ELEMENTARY GRADE TEACHER I 22600.00 STEP 2 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
1/1/2019 12/31/2019 ELEMENTARY GRADE TEACHER I 20179.00 STEP 2 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
1/1/2018 12Q/31/2018 ELEMENTARY GRADE TEACHER I 20179.00 STEP 2 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
1/1/2017 12/31/2017 ELEMENTARY GRADE TEACHER I 19620.00 STEP 1 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE REGULAR/
8/10/2015 12/31/2016 ELEMENTARY GRADE TEACHER I 18549.00 STEP 1 PERMANENT
Y
DIVISION BURAUEN SOUTH
DEPARTMENT OF EDUCATION LEYTE CONTRACTUA
6/6/2013 03/31/2015 KINDER VOLUNTER TEACHER 3000.00 N/A N
DIVISION BURAUEN SOUTH L
STO. NIŇO INSTITUTE OF SCIENCE & CONTRACTUA
6/6/2012 03/31/2013 PRIVATE ELEMENTARY GRADE TEACHER TECHNOLOGY
7000.00 N/A N
L
SAINT JUDE OF CHRISTIAN SCHOOL OF CONTRACTUA
6/6/2010 03/31/2011 PRIVATE ELEMENTARY GRADE TEACHER 6000.00 N/A N
QUEZON CITY L
CONTRACTUA
1/6/2009 03/31/2010 PRIVATE ELEMENTARY GRADE TEACHER ILANG-ILANG LEARNING CENTER 4000.00 N/A N
L
 (Continue on separate sheet if necessary)

SIGNATURE DATE 01/19/2023

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 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
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
DISTRICT-BASED TRAINING FOR KEY STAGE 1 TEACHERS ON LITERACY ON
2/4/2022 2/4/2022 8 TECHNICAL DEPED LEYTE
LITERACY INSTRUCTION
INSET 2.0 VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 08/30/21 09/03/21 40 TECHNICAL DEPED PASIG CITY
DISTRICT-BASED TRAINING ON DEPED COMPUTERAZATION PROGRAM(DCP)
01/21/2019 01/23/2019 32 TECHNICAL DEPED LEYTE
PROCESSES AND OFFICE 365 EMPOWERMENT PROGRAM
THREE-DAY District-based CAPABILITY BUILDING FOR KINDERGARTEN AND
10/21/2019 10/23/2019 32 TECHNICAL DEPED LEYTE
SPED TEACHERS IN HANDLING CO-CORRICULAR ACTIVITIES
07/25/2019 07/27/2019 32 TECHNICAL DEPED LEYTE
NG/WORKSHOP ON CONTEXTUALIZATION IN MOTHER TONGUE BASED MULTI-LINGUAL EDUCTION (MTB-MLE)
FOUR-DAY DISTRICT TRAINING WORKSHOP ON DIFFERENT TEACHING
STRATEGIES IN READING, MATHEMATICS, SCIENCE AND ARALING PANLIPUNAN 05/27/2019 05/30/2019 32 TECHNICAL DEPED LEYTE
AS KEY TO LITERACY
THREE-DAY DISTRICT-BASED PERFORMANCE SYSTEM (RPMS) 9/27/2018 9/29/2018 24 TECHNICAL DEPED LEYTE
DISTRICT TRAINING ON INCLUSIVE EDUCATION AND MULTI-FACTORED
07/13/2018 07/15/2018 24 TECHNICAL DEPED LEYTE
ASSESSMENT TOOL(MFAT)
ORIENTATION ON NUTRITIONAL ASSESSMENT FOR NUTRITION
04/18/2018 04/18/2018 8 TECHNICAL DEPED LEYTE
TEACHERS/COORDINATORS
ORIENTATION ON THE UTILIZATION OF THE FINANCIAL MANAGEMENT
02/22/2018 02/24/2018 24 TECHNICAL DEPED LEYTE
OPERATIONS MANUAL (FMOM)

(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)

SINGING N/A N/A

PLAYING SPORTS

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/19/2023

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 ✘

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
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
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
DELIA B. ENABORE BURAUEN LEYTE N/A 3.5 cm. X 4.5 cm
(passport size)

DOVER D. CONDE BURAUEN LEYTE N/A With full and handwritten

name tag and signature over
printed name
JOEBAN R. PAZA BURAUEN LEYTE N/A
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: NATIONAL ID 4930-2586-1360-4153
ID/License/Passport No.: PRC # 1136677
Signature (Sign inside the box)

Date/Place of Issuance: 02/26/2012/TACLOBAN

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