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 TAGA
FIRST NAME ELMA NAME EXTENSION SR, JR N/A

MIDDLE NAME CUDAL

3. DATE OF BIRTH 2/11/1970 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH KIBAWE BUKIDNON If holder of dual citizenship, Pls. indicate country:

5. SEX Male ✘ Female please indicate the details.

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

Widowed Separate House/Block/Lot No. Street
Other/s: d PUROK 1 NASULI
Subdivision/Village Barangay
7. HEIGHT (m) 1.49 M MALAYBALAY CITY BUKIDNON
City/Municipality Province
8. WEIGHT (kg) 60 KG ZIP CODE 8700
9. BLOOD TYPE AB 18. PERMANENT ADDRESS N/A N/A
House/Block/Lot No. Street
10.GSIS ID NO. 70110201913 PUROK 1 NASULI
Subdivision/Village Barangay
11.PAG-IBIG ID NO. 1820-0050-7761 MALAYBALAY CITY BUKIDNON
City/Municipality Province
12. PHILHEALTH NO. 17-00007 3693-9 ZIP CODE 8700
13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 936-784-362 20. MOBILE NO. 09978503451

15. AGENCY EMPLOYEE NO. 1590151 21. E-MAIL ADDRESS (if any) elma.taga001@dep.ed.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME TAGA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME CAESAR

NAME EXTENSION JR DREXELLE JUNE C. TAGA 07/25/1993
N/A
MIDDLE NAME FAHIGAL JAKE ANTHONY C. TAGA 11/20/1991
OCCUPATION BRGY. ELECTRICIAN JREL KENT C. TAGA 12/18/1989
EMPLOYER/BUSINESS NAMBUSECO

BUSINESS ADDRESS CASISANG MLYBLY CITY

TELEPHONE NO. N/A
24. FATHER'S SURNAME CUDAL
NAME EXTENSION SR/JR
FIRST NAME JULIAN N/A

MIDDLE NAME SALVADOR

25. MOTHER'S MAIDEN NAME

SURNAME VALERIO
FIRST NAME REMEDIOS
MIDDLE NAME ASENERO (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND HIGHEST
BASIC PERIOD OF
NAME OF SCHOOL LEVEL/ SCHOLARSHIP/
26. EDUCATION/DEGREE/COURSE UNITS YEAR
ACADEMIC
LEVEL ATTENDANCE EARNED
GRADUATED
HONORS
RECEIVED
From To (if not
(Write in full) graduated)
VOCATIONAL
ELEMENTARY/ SIMAYA ELEMENTARY SCHOOL ELEMENTARY 1977 1984 GRADUATED 1984 WITH HONOR

SECONDARY BANGCUD NATIONAL HIGH / S HIGH SCHOOL 1984 1988 GRADUATED 1988 N/A
MINDANAO ARTS AND
MIDWIFERY 1988 1989 49 units N/A N/A
TECHNOLOGICAL INSTITUTE
SAN AGUSTIN INSTITUTE OF BACHELOR IN ELEMENTARY
COLLEGE 1997 2001 GRADUATED 2001 N/A
TECHNOLOGY EDUCATION
TRADE EDUCATIONAL
GRADUATE
COURSE STUDIES BUKIDNON STATE UNIVERSITY 2001 2004 42-UNITS N/A N/A
ADMINISTRATION
(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

RA 1080 ( PROFESSIONAL TEACHER) 77.0 08/25/2002 CAMAMAN-AN CAGAYAN DE ORO CITY 762777 2/11/2024

(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.
SALARY/
JOB/ PAY GOV'T
28. GRADE (if SERVICE
INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY applicable)
MONTHLY STATUS OF
(Write in SALARY
& STEP
APPOINTMENT
(Format
(Write in full/Do not abbreviate) full/Do not abbreviate) "00-0")/
From To INCREME
NT
(Y/ N)
1/1/2023 TO DATE MASTER TEACHER I DEP-ED DIVISION OF MALAYBALAY CITY P 46,725.00 18-1 PERMANENT Y

1/1/2022 12/31/2022 TEACHER III DEP-ED DIVISION OF MALAYBALAY CITY P30,111.00 13-2 PERMANENT Y

1/1/2018 01/22/2018 TEACHER III DEP-ED DIVISION OF MALAYBALAY CITY P24,224.00 13-1 PERMANENT Y

01/30/2017 12/31/2017 TEACHER II DEP-ED DIVISION OF MALAYBALAY CITY P21,868.00 12-1 PERMANENT Y

1/1/2017 01/29/2017 TEACHER II DEP-ED DIVISION OF MALAYBALAY CITY P21,626.00 11-1 PERMANENT Y

09/22/2006 06/30/2007 TEACHER I DEP-ED DIVISION OF MALAYBALAY CITY P9,939 11-1 PERMANENT Y

9/2/2005 09/21/2006 TEACHER I DEP-ED DIVISION OF BUKIDNON-TALAKAG P9,939 11-1 PERMANENT Y

09/23/2003 11/21/2003 TEACHER I DEP-ED DIVISION OF MALAYBALAY CITY P9,939 11-1 SUBSTITUTE Y

(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 NUMBER OF
(Write in full) (mm/dd/yyyy) 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 NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) HOURS Supervisory/ (Write in full)
Technical/etc)
From To
BUREAU OF LEARNER SUPPORT
ONLINE COURSE INFECTION PREVENTION AND CONTROL IN
SCHOOLS
3/24/2023 3/24/2023 8 TECHNICAL SERVICES DEPED CENTRAL
OFFICE
DEPARTMENT OF EDUCATION
READING DIFICULTIES FOCUSES ON READING INTERVENTION (INSET) 2/9/2023 2/10/2023 16 TECHNICAL
DIVISION OF MALAYBALAY CITY
DEPARTMENT OF EDUCATION
DIVISION RETOOLING AND WORKSHOP ON TEST CONSTRUCTION 2/7/2023 2/7/2023 8 TECHNICAL
SCHOOL BASED ANNUAL GENDER AND DEVELOPMENT (GAD) DIVISION OF MALAYBALAY CITY
TRAINING ON MENTAL HEALTH, WELLNESSS AND DEPARTMENT OF EDUCATION
DEVELOPMENT
7/7/2022 7/8/2022 16 MANAGERIAL
DIVISION OF MALAYBALAY CITY
GAD (GENDER AND DEVELOPMENT MENTAL HEALTH WELLNESS AND DEPARTMENT OF EDUCATION
DEVELOPMENT
7/7/2022 7/8/2022 16 TECHNICAL
DIVISION OF MALAYBALAY CITY
IN-SERVICE TRAINING WITH THE TOPIC 5'S SYSTEM IMPORTANT OF 5'S IN THE DEPARTMENT OF EDUCATION
WORK PLACE.
3/15/2021 3/19/2021 24 TECHNICAL
DIVISION OF MALAYBALAY CITY
DEPARTMENT OF EDUCATION
LEARNING DELIVERY MODALITIES COURSE 2 (LDM2) 9/15/2020 9/22/2020 16 TECHNICAL
DIVISION OF MALAYBALAY CITY
(MEST)2019 INTERNATIONAL MIND EDUCATION SPECIALIST TRAINING FOCUS DEPARTMENT OF EDUCATION
ON
11/15/2019 11/17/2019 24 TECHNICAL
DIVISION OF MALAYBALAY CITY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
ASSOCIATION/ORGANI
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. ZATION
(Write in full)
(Write in full)
CROSS- STITCHING N/A N/A
COOKING

(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 YES ✘ NO
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, 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 YES ✘ NO
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? 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
TEOFIL0 L. ONTOY JR P2,LPT MALAYBALAY CITY 9178880495 3.5 cm. X 4.5 cm
(passport size)

SONNY M.ROJAS, PII ,LPT MALAYBALAY CITY 9055954353 With full and handwritten
name tag and signature over
printed name
ARCHILLE B. CONOL MALAYBALAY CITY 9177077428
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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 No762777 Signature (Sign inside the box)

5/18/2023
Date/Place of Issuance11/6/2002-CAGAYAN DE ORO CIT 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