CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 NITURAL
NAME EXTENSION (JR., SR) N/A
FIRST NAME JOJO

MIDDLE NAME GODOY

3. DATE OF BIRTH
(mm/dd/yyyy) 09/20/1982 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH PINAMALAYAN, ORIENTAL MINDORO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS CENTRO
Widowed Separated House/Block/Lot No. Street
PANGGULAYAN
Other/s:
Subdivision/Village Barangay
PINAMALAYAN ORIENTAL MINDORO
7. HEIGHT (m) 1.63
City/Municipality Province
8. WEIGHT (kg) 69 ZIP CODE 5208

18. PERMANENT ADDRESS CENTRO

9. BLOOD TYPE O
House/Block/Lot No. Street
PANGGULAYAN
10. GSIS ID NO. 02003504720
Subdivision/Village Barangay
PINAMALAYAN ORIENTAL MINDORO
11. PAG-IBIG ID NO. 1490-0098-9559
City/Municipality Province

12. PHILHEALTH NO. 09-025048601-3 ZIP CODE 5208

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

14. TIN NO. 238-624-923-000 20. MOBILE NO. 09072531857 / 09553159649

15. AGENCY EMPLOYEE NO. 4358973 21. E-MAIL ADDRESS (if any) [email protected]
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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME NITURAL

NAME EXTENSION (JR., SR)
FIRST NAME RUBEN N/A

MIDDLE NAME LOZANO

25. MOTHER'S MAIDEN NAME

SURNAME GODOY

FIRST NAME EUFEMIA

MIDDLE NAME NEBREJA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PANGGULAYAN ELEMENTARY SCHOOL PRIMARY EDUCATION 1989 1995 N/A 1995 N/A

SECONDARY /
VOCATIONAL IMMACULATE HEART OF MARY ACADEMY HIGH SCHOOL 1995 1999 N/A 1999 N/A

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

TRADE
COURSE
COLLEGE ABADA COLLEGE BACHELOR OF ELEMENTARY EDUCATION 1999 2003 N/A 2003 N/A

GRADUATE STUDIES UNIVERSITY OF BATANGAS MASTER OF ARTS MAJOR IN FILIPINO 2013 15 N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 18, 2018 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 75.00 8/31/2003 TORRES HIGH SCHOOL, TONDO, MANILA 0809464 9/20/2020

(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 /
01/01/2018 PRESENT ELEMENTARY GRADE TEACHER 2 22410.00 12-2 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
01/01/2017 12/31/2017 ELEMENTARY GRADE TEACHER 2 21387.00 12-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
01/01/2016 12/31/2016 ELEMENTARY GRADE TEACHER 2 20651.00 12-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
07/08/2014 12/31/2015 ELEMENTARY GRADE TEACHER 2 19940.00 12-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
06/01/2012 07/07/2014 ELEMENTARY GRADE TEACHER 1 18735.00 11-2 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
09/01/2011 05/31/2012 ELEMENTARY GRADE TEACHER 1 17318.00 11-2 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
06/01/2011 08/31/2011 ELEMENTARY GRADE TEACHER 1 17099.00 11-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
06/24/2010 05/31/2011 ELEMENTARY GRADE TEACHER 1 15649.00 11-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
07/01/2009 06/23/2010 ELEMENTARY GRADE TEACHER 1 14198.00 11-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
07/01/2008 06/30/2009 ELEMENTARY GRADE TEACHER 1 12026.00 10-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT
DEPARTMENT OF EDUCATION /
01/09/2008 06/30/2008 ELEMENTARY GRADE TEACHER 1 10933.00 10-1 PERMANENT YES
PINAMALAYAN WEST DISTRICT

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 18, 2018 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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
DIVISION ROLL-OUT SEMINAR ON FINANCIAL MANAGEMENT OPERATIONS DEPARTMENT OF EDUCATION - DIVISION OF
10/23/2017 10/24/2017 16 TECHNICAL
MANUAL ORIENTAL MINDORO
NATIONAL SEMINAR-WORKSHOP ON PREPARING QUALITYTEACHING AND CENTER FOR THE PROFESSIONAL
05/08/2017 05/10/2017 24 TECHNICAL
LEARNING RESOURCES INCLUDING ICT FOR THE K TO 12 CLASSROOM ADVANCEMENT OF EDUCATORS
PANGGULAYAN ELEMENTARY SCHOOL
2016 SCHOOL - BASED MID - YEAR INSET 10/24/2016 10/28/2016 40 TECHNICAL

DEPARTMENT OF EDUCATION - DIVISION OF

DIVISION TRAINING WORKSHOP OF TEACHERS ON SPORTS COACHING 10/27/2016 10/29/2016 24 TECHNICAL
ORIENTAL MINDORO
ICT LITERACT WORKSHOPTRAINING OF TRAINERS AND ICT LITERACY DEPARTMENT OF EDUCATION - DIVISION OF
10/20/2016 10/21/2016 16 TECHNICAL
WORKSHOP FOR TEACHERS ORIENTAL MINDORO
DIVISION TRAINING OF UNTRAINED GRADE 1 TO GRADE 5 TEACHERS ON K TO DEPARTMENT OF EDUCATION - DIVISION OF
08/17/2016 08/19/2016 24 TECHNICAL
12 BASIC EDUCATION PROGRAM ORIENTAL MINDORO
DIVISION ORIENTATION/BRIEFING OF RECIPIENT PUBLIC ELEMENTARY AND SECONDARY SCHOOLS UNDER DCP DEPARTMENT OF EDUCATION - DIVISION OF
BATCHES 29,30, & 33 06/09/2016 06/10/2016 24 TECHNICAL
ORIENTAL MINDORO
PANGGULAYAN ELEMENTARY SCHOOL
2015 SCHOOL - BASED MID - YEAR INSET 10/26/2015 10/30/2015 40 TECHNICAL

DISTRICT TRAINING WORKSHOP ON CAMPUS JOURNALISM FOR SCHOOL DEPARTMENT OF EDUCATION -

10/13/2015 10/14/2015 16 TECHNICAL
PAPER ADVISERS PINAMALAYAN WEST
PANGGULAYAN ELEMENTARY SCHOOL
2015 SCHOOL - BASED SUMMER INSET 05/25/2015 05/29/2015 40 TECHNICAL

24th ANNUAL CONVENTION AND 3rd NATIONAL SEMINAR - WORKSHOP ON DEPARTMENT OF EDUCATION - NATIONAL
11/28/2014 11/30/2014 24 TECHNICAL
EDUKASYON SA PAGPAPAKATAO EDUKASYON SA PAGPAPAKATAO
DEPARTMENT OF EDUCATION - DIVISION OF
DIVISION SEMINAR ON CHILD PROTECTION 08/25/2014 08/27/2014 24 TECHNICAL
ORIENTAL MINDORO
DIVISION ORIENTATION SEMINAR ON DEPED COMPUTERIZATION PROGRAM: TRENDS, TOOLS AND DEPARTMENT OF EDUCATION - DIVISION OF
TRAINING ON ICT EDUCATION 03/20/2014 03/22/2014 24 TECHNICAL
ORIENTAL MINDORO
DEPARTMENT OF EDUCATION - DIVISION OF
ORIENTATION WORSHOP ON THE SCHOOL FEEDING PROGRAM 05/16/2013 05/17/2013 16 TECHNICAL
ORIENTAL MINDORO

(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
(Write in full)
in full)

PINAMALAYAN WEST DISTRICT TEACHERS

TYPING, COMPUTER LITERATE N/A
CLUB
BASKETBALL, TENNIS

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 18, 2018 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
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
STA. MARIA, PINAMALAYAN, ORIENTAL the last 6 months
SAPUNGAN, RONILO M. MINDORO
09285212513 3.5 cm. X 4.5 cm
(passport size)
QUEZON ST.,ZONE III,PINAMALAYAN,
AGUSTINO,RAMIL M. ORIENTAL MINDORO
09395511979 With full and handwritten
name tag and signature over
PAMBISAN MUNTI, PINAMALAYAN, printed name
MANAHAN, DANTE R. ORIENTAL MINDORO
09491875962
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 administrative/criminal case/s PHOTO
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 LICENSE

ID/License/Passport No.: 0809464

Signature (Sign inside the box)
JULY 18, 2018
Date/Place of Issuance: 02/24/2017 / MANILA
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this July 18, 2018 , affiant exhibiting his/her validly issued government ID as indicated above.

FLORIFE F. LLANTO,Ph.D.

PRINCIPAL - IV
Person Administering Oath

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