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 BALAOING
NAME EXTENSION (JR., SR)
FIRST NAME HIYAS

MIDDLE NAME CABRIDO

3. DATE OF BIRTH
(mm/dd/yyyy) 1/11/1981 16. CITIZENSHIP ✘

4. PLACE OF BIRTH Polomolok, South Cotabato If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘

✘ 17. RESIDENTIAL ADDRESS Sanfrancisco

6 CIVIL STATUS
House/Block/Lot No. Street
New Pangasinan
Subdivision/Village Barangay
City of Koronadal South Cotabato
7. HEIGHT (m) 5'5
City/Municipality Province
8. WEIGHT (kg) 68 ZIP CODE 9506

18. PERMANENT ADDRESS Sanfrancicso

9. BLOOD TYPE A+
House/Block/Lot No. Street
New Pangasinan
10. GSIS ID NO. N/A
Subdivision/Village Barangay
City of Koronadal South Cotabato
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 9506

13. SSS NO. 09-268657-5 19. TELEPHONE NO.

14. TIN NO. 441-136-143-000 20. MOBILE NO. 09513612594

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) hiyasbalaoing@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME Balaoing 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
JR. ALEXANDRIA MAY C. CAMARCE
FIRST NAME Valentin 5/11/2009

MIDDLE NAME DELOS REYES

OCCUPATION FARMER

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. 09091026015

24. FATHER'S SURNAME COCOS

JR.
FIRST NAME VENANCIO

MIDDLE NAME GARA

25. MOTHER'S MAIDEN NAME

SURNAME CABRIDO

FIRST NAME MIRIAM

MIDDLE NAME ABAD (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 GLAN PADIDU ELEMENTARY SCHOOL 1986 1992 1992

SECONDARY /
VOCATIONAL KIAMBA NATIONAL HIGH SCHOOL 1992 1998 1998

TRADE
COURSE
COLLEGE KING'S COLLEGE OF MARBEL INC. BACHELOR OF SECONDARY EDUCATION 1998 2002 2002

GRADUATE STUDIES

(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

N/A

(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)
CITY SOCIAL WELFARE DEVELOPMENT
2011 PRESENT DAY CARE WORKER VOLUNTEER
OFFICE

(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

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
TRAINING WORKSHOP ON CURRICULUM PLANNING AND DEVELOPMENTALLY
11/17/2020 11/18/2020 14 HRS. CITY GOVERNMENT OF KORONADAL CITY
APPROPRIATE LEARNING ACTIVITIES AND INTEGREATING ECCD IN EMERGENCIES

ECCD CURICULUM FOR 3 TO 4 YEARS OLD CHILDREN 11/3/2021 11/10/2021 20 HRS. CITY GOVERNMENT OF KORONADAL CITY

ASSESMENT TOOL FOR GRANTING OF RECOGNITION TO CDC/LC OFFERING EARLY

10/21/2022 10/21/2022 7 HRS. PROVINCIAL GOVERNMENT OF SOUTH COTABATO
CHILDHOOD PROGRAMS FOR 0-4 YEARS OLD
WRITESHOP ON CREATION OF 5&4 AND ANNUAL WORK AND FINANCIAL PLAN FOR
5/30/2023 5/31/2023 14 HRS. CITY GOVERNMENT OF KORONADAL CITY
DCC/CDC

ASSESMENT TOOL FOR GRANTING OF RECOGNITION TO CDC WITH LEARNING CENTERS

6/9/2023 6/9/2023 8 HRS. PROVINCIAL GOVERNMENT OF SOUTH COTABATO
OFFERING EARLY CHILDHOOD PROGRAMS FOR 0-3 YEARS OLD AND FILIPINO CHILDREN

GUIDING ECE LEADERS, ECE TEACHERS/CDT/CDW IN KINDERGARTED CLASSROOM/CDC

UNIVERSITY OF SCIENCE & TECHNOLOGY OF
STRUCTURING AND ECE CURRICULUM DEVELOPMENT; WEEKLY ACTIVITY/SESSION 7/13/2023 7/14/2013 14 HRS.
SOUTHERN PHILIPPINES
PLANNING FOR ITED, PRE K1 AND PRE K2

MENTAL AND BEHAVIORAL MANAGEMENT 11/22/2023 11/24/2023 20 HRS. PROVINCIAL GOVERNMENT OF SOUTH COTABATO

(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 TYPING

(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? ✘

b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
AUNTIE

35. a. Have you ever been found guilty of any administrative offense? ✘

If YES, give details:

________________________________
________________________________
b. Have you been criminally charged before any court? ✘

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?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ✘
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 ✘
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last ✘

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? ✘

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? ✘
If YES, please specify:
b. Are you a person with disability? ✘

If YES, please specify ID No:

c. Are you a solo parent? ✘

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
DEBORAH C. PADER CITY OF KORONADAL 09124469711 4.5 cm. X 3.5 cm
(passport size)

ROSIE JEAN T. CABRIDO CITY OF KORONADAL 09122458448

Computer generated
or photocopied picture
ELMER CASTOR CITY OF KORONADAL 09078722588 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: LGU-CDWA

ID/License/Passport No.: 0096

Signature (Sign inside the box)

Date/Place of Issuance: N/A

Date Accomplished Right Thumbmark

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

DEBORAH C. PADER
Person Administering Oath

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